I’ve seen a few articles about the effect of strontium supplements on osteoporosis. What do you think?

Response from Gayle Nicholas Scott, PharmD, BCPS, ELS Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia

Strontium is located on the periodic table in the alkali earth metal group, the same group that includes calcium. Strontium is used for a variety of indications ranging from an ingredient in toothpaste for sensitive teeth (Sensodyne®, GlaxoSmithKline, Research Triangle Park, North Carolina) to strontium-89 (Metastron™, GE Healthcare, Waukesha, Wisconsin) for metastatic bone pain. Strontium is widely promoted for treatment of osteoporosis. In Europe, strontium ranelate is available as a prescription drug. In the United States, strontium is a dietary supplement available as the carbonate, chloride, citrate, gluconate, and sulfate salts. The US Food and Drug Administration (FDA) granted strontium malonate investigational new drug (IND) status.

Most drugs for osteoporosis inhibit bone resorption. Available antiresorptive agents include bisphosphonates (alendronate, risedronate, ibandronate, and zoledronic acid), estrogen, selective estrogen modulators (raloxifene), and calcitonin. Parathyroid hormone (teriparatide) and fluoride stimulate bone formation. Strontium ranelate is unique in that it appears to act by both of these mechanisms.^[1]

Strontium ranelate is comprised of 2 atoms of strontium and the organic acid ranelic acid. Product information about strontium ranelate on the Website of the European Medicines Agency, the European Union equivalent of the FDA, explains the choice of the ranelate salt with “the organic part permit[s] the best compromise in terms of molecular weight, pharmacokinetics and acceptability of the medicinal product.”^[1] The bioavailability of strontium ranelate ranges from 19% to 27%; food and calcium products reduce its already low bioavailability by 60%-70%.^[1]

The safety and efficacy of strontium ranelate for osteoporosis have been investigated in 4 randomized, double-blind, placebo-controlled trials. Three trials evaluated strontium ranelate 0.5-2 g/day for osteoporosis treatment,^[2-4] and 1 study evaluated 125 mg-1 g/day for osteoporosis prevention.^[5] For treatment, strontium ranelate 2 g/day for 3 years reduced vertebral fractures by 37% (relative risk [RR] 0.63; 95% confidence interval [CI] 0.56, 0.71) and nonvertebral fractures by 14% (RR 0.86; 95% CI 0.75, 0.98). Lower doses were superior to placebo, but reduction in vertebral fractures and increase in bone mineral density were greater with 2 g/day.^[6] A recent study of women with osteoporosis taking strontium ranelate 2 g daily for 8 years showed sustained increases in bone mineral density.^[7] In all studies, patients took supplemental calcium and vitamin D.

Diarrhea is the most common adverse effect associated with strontium ranelate, usually occurring with higher doses. Data suggest that patients receiving strontium 2 g/day for 3-4 years have a higher risk for vascular side effects (eg, blood clots) and nervous system side effects (eg, seizures).^[6]

All research published in peer-reviewed journals is on strontium ranelate. A phase 2 study on strontium malonate has been published as a meeting abstract.^[8] No credible research is available on other strontium salts, and the bioavailability and effectiveness of these products are unknown.

For patients concerned about osteoporosis prevention, emphasize the importance of weight-bearing exercises and adequate calcium and vitamin D intake. For patients with diagnosed osteoporosis, FDA-approved treatments are indicated. Tell patients that dietary supplements containing strontium are unproven and should be avoided.

http://www.medscape.com/viewarticle/714870?src=mp&spon=17&uac=75614MR

Biomechanics: Barefoot running is better?

This article just published in Nature (the most prestigious science journal above all others)  explains the differences in the biomechanics of running with vs. running without shoes.  One difference I thought was interesting was the fact that better shock absorption occurs from surrounding lower extremity musculature without shoes.   ”As their feet collide with the ground–in this case, a running track–barefoot runners experience a shock of only 0.5 to 0.7 times their body weight, whereas shod heel strikers experience 1.5 to two times their body weight–a threefold to fourfold difference.”

Nature 463, 433-434 (28 January 2010) | doi:10.1038/463433a; Published online 27 January 2010

William L. Jungers1

Abstract: Detailed analyses of foot kinematics and kinetics in barefoot and shod runners offer a refined understanding of bipedalism in human evolution. This research will also prompt fresh studies of running injuries.

A commitment to walking and running on two legs distinguishes humans from apes, and has long been the defining adaptation of the hominins — the lineages that include both humans and our extinct relatives. This form of locomotion (bipedalism) has been around for millions of years, and we have been unshod for more than 99% of that time1.

1.William L. Jungers is in the Department of Anatomical Sciences, Stony Brook University Medical Center, Stony Brook, New York 11794-8081, USA.
Email: william.jungers@stonybrook.edu

Read more comments about this article:  http://sciencenow.sciencemag.org/cgi/content/full/2010/127/1

The Calcium Side Your Bones Crave

By RealAge

Keep your skeleton strong and fracture-free by serving that calcium supplement with a salad on the side.

Salad? Yep, salad. A 4-year study found that older adults with the highest intakes of carotenoids — think tomatoes, carrots, and leafy greens for major sources — retained more bone mineral density than folks eating fewer fruits and veggies.

Antioxidant Bone Protection
Fruits and vegetables are bursting with antioxidants called carotenoids — including compounds like lycopene, beta carotene, lutein, and zeaxanthin, to name a few. Don’t bother trying to pronounce them. Just know that veggie-stacked salads will probably provide your daily needs and then some.

How They Work
Carotenoids may protect bones by stymieing the oxidative stress thought to play a role in age-related weakening of bones. Carotenoids may also act synergistically with vitamin D to boost bone-cell growth. Still need more reasons to eat extra fruits and veggies?

Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Sahni, S. et al., American Journal of Clinical Nutrition 2009 Jan;89(1):416-424.

My Dear Friend’s Story about Cancer and the Pilates Community

My dear friend, Gay Barnes’ story about the overwhelming support from the Pilates Community – Published in the Pilates Coreterly Newsletter from Balanced Body
- By Gay Barnes and Jackie Gordon
One year ago today I completed chemo. Thank you for your extraordinary gifts, generous healing thoughts and prayers. I am, and always will be, overwhelmed by the community that I am lucky enough to be a part of and supported by. I believe it is because of you that I am here to celebrate my “Rebirth day.” I will be thinking of you with great appreciation as I celebrate.
May you be well.
I sent this email out July 1, 2009 after I finished one year of radical chemo- therapy treatment.
I’ve been in the fitness industry for over 25 years and a Pilates instructor at Synergy for the last 10 years. I have never been involved in anything quite like Pilates. Not only is it the most effective exercise I’ve ever done, but the people I have met and worked with have been extraordinary. It really is a close-knit community.
I never knew how important that community was until January of 2008.
I was diagnosed with Stage 3C ovarian cancer and had a radical hysterectomy the following month. The post-surgery recovery and radical chemotherapy left me almost completely debilitated. The treatment (specific for ovarian cancer) required six different installments. Each round of chemo, I.V. & I.P., included two nights in the hospital and one day in an outpatient chemo area. The first took place within three weeks of the surgery and then repeated every 21 days for six cycles. The effects on my body were overwhelming. Each treatment was worse than the last and left me exhausted and sick..… Read More »

Pilates hurts my neck!

Lindy Royer, PT and Polestar Pilates Educator, demonstrates the correct cervical alignment for preparing the neck for more advanced Pilates work.  Watch Lindy as she shows the head hover for gradual strengthening of the neck for Pilates on her You Tube video!

Johns Hopkins Health Alert: Common GERD Drug Increases Risk of Osteoporosis

Proton pump inhibitors (PPIs) treat GERD and ulcers by limiting the production of caustic gastric acids. The problem: Gastric acids are a vital component of digestion. Blocking them may interfere with the absorption of calcium, which is essential for maintaining strong bones. By limiting calcium absorption, PPIs may put you at greater risk for developing osteoporosis. If you have osteoporosis, taking a PPI may increase your fracture risk. Here’s what you need to know …

Read more: http://www.johnshopkinshealthalerts.com/alerts/back_pain_osteoporosis/JohnsHopkinsHealthAlertsBackPainOsteoporosis_3279-1.html?ET=johnshopkins_blog:e35877:221674a:&st=email&st=email&st=email&s=EBH_100115_013

Type of delivery is not affected by light resistance and toning exercise training during pregnancy: a randomized controlled trial.

Am J Obstet Gynecol. 2009 Dec;201(6):590.e1-6. Epub 2009 Jul 15.

Type of delivery is not affected by light resistance and toning exercise during pregnancy: a randomized controlled trial.

Barakat R, Ruiz JR, Stirling JR, Zakynthinaki M, Lucia A.

Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Spain.

OBJECTIVE: We examined the effect of light-intensity resistance exercise training that is performed during the second and third trimester of pregnancy by previously sedentary and healthy women on the type of delivery and on the dilation, expulsion, and childbirth time. STUDY DESIGN: We randomly assigned 160 sedentary women to either a training (n=80) or a control (n=80) group. We recorded several maternal and newborn characteristics, the type of delivery (normal, instrumental, or cesarean), and dilation, expulsion, and childbirth time. RESULTS: The percentage of women who had normal, instrumental, or cesarean delivery was similar in the training (70.8%, 13.9%, and 15.3%, respectively) and control (71.4%, 12.9%, and 15.7%, respectively) groups. The mean dilation, expulsion, and childbirth time did not differ between groups. CONCLUSION: Light-intensity resistance training that is performed over the second and third trimester of pregnancy does not affect the type of delivery.

PMID: 19608151 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19608151?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2

A MRI Investigation of the Transversus Abdominis Muscle During Drawing-in of the Abdominal Wall in Elite Australian Football League Players With and Without LBP

A MRI Investigation of the Transversus Abdominis Muscle During Drawing-in of the Abdominal Wall in Elite Australian Football League Players With and Without LBP:  Read abstract at:  http://www.jospt.org/issues/articleID.2381,type.1/article_detail.asp

Pilates-Based Exercise for Fall Risk Reduction in Older Adults: A Pilot Study

My colleagues, Dawn-Marie Ickes, Gabrielle Shrier and Allyson Cabot are presenting their study at the APTA CSM Scientific Meeting this year: Pilates-Based Exercise for Fall Risk Reduction in Older Adults: A Pilot Study M. Roller1; A. F. Kachingwe1; D. Ickes2; A. L. Cabot2; G. Shrier2; J. Beling1 1. Physical Therapy, California State University, Northridge, Northridge, CA, United States. 2. Core Conditioning, Studio City, CA, United States.

Falls are a common cause of morbidity and mortality in older adults. Impairments in balance, strength, range of motion, and functional mobility can lead to increased fall risk. Pilates is a form of exercise designed to improve core strength, flexibility, and functional mobility, making it an exceptional form of exercise for individuals at risk for falls. The purpose of this study was to investigate the effects of a Pilates-based exercise intervention in improving balance and reducing fall risk with a population of adults over 65 who are known fallers or at risk for falls.8 subjects (5 males, 3 females; mean age 78.6 years) participated in the study. Inclusion criteria included a self-reported history of two or more falls or one injurious fall in the past year or a Timed Up and Go (TUG) test of >13.5 seconds suggesting risk for falling. Six subjects completed the intervention and post-testing. Subjects attended 10 sessions of a 45-minute Pilates-based exercise program once a week at Core Conditioning in Studio City, CA. Pilates training utilized the Balanced Body® Pilates Studio Reformer® under the supervision of a physical therapist who is a Gold Certified PMA Pilates Instructor with 9 years of experience using this methodology. Participant to instructor ratio was 4:1 with all subjects working on Reformers concurrently in a group class format. Each subject performed 10 specific exercises, 10 repetitions each, using varying resistance of 2-4 springs progressed according to each participant’s ability. Outcome measures: Activities-specific Balance Confidence (ABC) scale; Timed Up-and-Go (TUG) test; Berg Balance Scale (BBS; Computerized Dynamic Posturography (CDP) on the NeuroCom Smart Equitest® including Sensory Organization Test (SOT), Adaptation Test (ADT) and Motor Control Test (MCT; Active Range of Motion (AROM) of ankle dorsiflexion, hip extension and straight-leg raise The following outcomes measures improved significantly at the p<0.05 level: TUG scores significantly decreased from 14.8 to 11.1 seconds suggesting reduced fall risk; SOT composite scores significantly increased from 55.7 to 64.2/100 suggesting increased postural stability; BBS scores significantly increased from 44.8 to 51.8/56 suggesting improved static and dynamic balance; Right ankle dorsiflexion AROM significantly increased from 5.2° to 10.3° Pilates-based exercise using the Reformer performed once per week resulted in significant improvements in static and dynamic balance, ankle range of motion, functional mobility, and reduced fall risk in eight adults over age 65 who were at risk for falling. This pilot study suggests that rehabilitation focusing on Pilates exercise using the Reformer only once a week is an excellent intervention to improve balance and decrease fall risk in older adults. Future randomized-controlled studies should be performed to further validate these findings.

Just what are the best exercises for healthy bones?

An article just came out last month in the NY Times on “The
Best Exercises for Healthy Bones”.  It was interesting to
say the least. The writer suggested that hopping was the
best exercise to build bone but gave no context or
guidelines to incorporate hopping or jumping safely into
an exercise program! I decided to pull together the best
information from the top researchers in the field of bone
and exercise. I like to look at the groups who have been
doing this kind of research for a long time.  I was at a bone
symposium last week and was able to ask Beth Lambright,
the Oregon State University exercise teacher of all the
main studies during the past 15 years if jumping rope or
mini-trampolines build bone. The answer was “No, you
need 4-8x body weight impact to stimulate bone. For
children this means jumping off a 24″ box and for adults
this means jumping off an 8″ step. They progress from 4″
to 6″ to 8″ very slowly and prepare the knees and hips
with step-ups, heel raises, squats, lunges and faux jumps
before jumping off the steps. So what else will give us
healthy bones?
1. Walking does not build bone and should not be
considered an osteoporosis exercise. (However, walking is
great for your heart if you keep up a good pace.)
Palombaro KM. “Effects of walking-only interventions on
bone mineral density at various skeletal sites: a metaanalysis.”
J Geriatr Phys Ther. 2005;28(3):102-7.
2. Weighted vests with lunges, squats, step ups, side
lunges and small jumps 3 x per week builds bone in the
hip according to Christine Snow’s bone research lab at
Oregon State University.
(Long-term Exercise Using Weighted Vests Prevents Hip
Bone Loss in Postmenopausal Women by Christine M.
Snow, Janet M. Shaw, Kerri M. Winters, and Kara A. Witzke
Journal of Gerontology: 2000, Vol. 55A, No. 9, M489-
M491) They are continuing their long-term studies and the
latest one should be published next month!
3. Sinaki has the best long-term research on exercise for
building bone and fracture prevention in the spine
(vertebral bodies).
(Sinaki, M., et al. 1986.”Relationship between bone
mineral density of spine and strength of back extensors in
healthy postmenopausal women.” Mayo Clinic
Proceedings, 61 (2), 116-22.)
(Sinaki, M., et al. 1996. “Can strong back extensors
prevent vertebral fractures in women with osteoporosis?”
Mayo Clinic Proceedings, 71 (10), 951-56.)
(Sinaki, M, et al. 2002. “Stronger back muscles reduce the
incidence of vertebral fractures: A prospective 10 year
follow-up of postmenopausal women.” Bone, 30 (6), 836-
41.)
(Sinaki, M”The role of physical activity in bone health: a
new hypothesis to reduce risk of vertebral fracture.” Phys
Med Rehabil Clin N Am. 2007 Aug;18(3):593- 608)
4. Loren Fishman has some ongoing research on Yoga for
osteoporosis and is getting some increases in BMD with
his program.
(Yoga for Osteoporosis: A Pilot Study by Loren M.
Fishman, MD. Topics in Geriatric Rehabilitation. Vol. 25,
No. 3, pp. 244-250: 2009)
Main Points for Exercising Your Bones:

• Hip Bone Building: Jumping is best. (If your T- score is below a -3.0 do not jump!) Prepare for jumping by doing forward and side lunges, squats, step ups, heel raises and standing balance exercises. Consider using a weighted vest up to 10% of your body weight. Mini-trampolines are a good warm-up or for cardiovascular work but they do not build bone.

• Spine Bone Building: Prone (face down) Back Extension Exercises are best.

• Walking briskly on uneven terrain up and down hills is great for your heart but should not be considered a bone building exercise.

• Yoga and Pilates in general are not considered bone building exercises YET! They may be effective programs to increase variety and pleasure with exercise and are a good body awareness fracture prevention and preparation for the bone loading exercises necessary to stimulate bone formation!