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Sr4.2
Strontium Research
Too few graded studies
9 peer-reviewed studies
What the evidence says
Too few graded studies
Strontium doesn't have enough studies with structured effect-size data yet to pool a verdict. Browse the studies below for individual findings.
Most evidence is from high-quality meta-analyses and randomised trials published 2002–2025 with a typical study size of 4,995 participants.
Based on 9 studies · 3 meta-analyses · 2 RCTs · 7,368 total participants
Confidence
High confidence
By outcome
Bone healthFracture-risk reduction shown for prescription ranelate; OTC citrate is far less proven · 12+ months
Too few graded studies9 studies
Safety profile
Too few graded studies1 study
Steady research
2 studies in the last 5 years · Latest meta-analysis: 2024
200220132025
1Review2025
In plain English: We consider here targeted therapeutics that are already in clinical practice, as well as the most promising novel agents that are now under development: antibodies, siRNAs, aptamers, and small molecules.
Omelchenko V, Koval V, Slazhneva N, Bondarenko N, Shatunova E, Vorobyeva M, Korolev M. · International journal of molecular sciences (2025)
Targeting pathways underlying bone metabolism could significantly improve the therapeutic options and provide new tools in the fight against osteoporosis.
Among them, there are bisphosphonates, strontium ranelate, calcitonin, estrogen-progestin therapy, selective estrogen receptor modulators, and parathyroid hormone analogues.
Otherwise, they suffer from certain disadvantages, such as adverse effects, including serious ones, and limitations associated with comorbidity.
In plain English: Collectively, our study suggests that AFMs improve bone quality, which explains their anti-fracture ability that is not fully accounted for by increased BMD in osteoporosis patients.
Sharma S, Shankar V, Rajender S, Mithal A, Rao SD, Chattopadhyay N. · Frontiers in endocrinology (2024)
Pooled analysis showed that AFMs significantly decreased cortical bone crystallinity [standardized difference in means (SDM) -1.394] and collagen maturity [SDM -0.855], and collagen maturity in cancellous bone [SDM -0.631].
Additionally, anti-resorptives (bisphosphonates and denosumab) significantly increased crystallinity [SDM 0.387], mineral-matrix ratio [SDM 0.771], microhardness [SDM 0.858], and contact hardness [SDM 0.952] of cortical bone.
Restricted analysis of only bisphosphonate-treated studies showed a significant decrease in collagen maturity [SDM -0.650] in cancellous bone and an increase in true hardness [SDM 1.277] in cortical bone.
5Meta-AnalysisCited 15×n=4,995 · very large study2010
In plain English: Significant reductions in vertebral fractures with strontium ranelate were seen in all tertiles of both markers, with relative risk reductions of 31% to 47% relative to placebo.
Collette J et al. · Osteoporos Int (2010)
Pooled post-hoc analysis of two randomised placebo-controlled trials in postmenopausal women with osteoporosis, stratified by baseline bone-turnover markers (b-ALP, n = 4995, and sCTX, n = 4891), strontium ranelate 2 g/day for 3 years
Strontium ranelate reduced vertebral fractures significantly in every tertile of both markers, by 31% to 47% relative to placebo
The reduction did not differ by baseline bone turnover (b-ALP p = 0.513, sCTX p = 0.290)
6Meta-AnalysisCited 22×n=2,373 · very large study2010
In plain English: The 3-month changes in BALP, PICP s-CTX I and s-NTX I were not significantly associated with fracture incidence.
Bruyere O et al. · Osteoporos Int (2010)
Pooled post-hoc analysis of 2,373 women treated with strontium ranelate in the SOTI and TROPOS trials
3-month changes in the bone-formation markers PICP and BALP, but not the resorption markers, were associated with 3-year spine and femoral neck BMD changes (p < 0.001)
Marker changes explained less than 8% of the BMD changes, and none was significantly associated with fracture incidence
In plain English: Based on all available data from primary publications and regulatory documents, the number of fractures prevented by strontium use is similar to the number of extra cases of venous thromboembolism, pulmonary embolism and myocardial infarction caused by strontium use.
Bolland MJ, Grey A · BMJ open (2014)
Compared 5 regulatory documents with 9 publications of 7 placebo-controlled trials of strontium ranelate.
The European Medicines Agency reported that strontium ranelate increases myocardial infarction risk in postmenopausal women, and the trials showed more venous thromboembolism and pulmonary embolism, which the publications under-reported.
The authors judge the risks of strontium ranelate similar to its benefits. The data concern the prescription ranelate salt, not strontium citrate.
In plain English: At the conclusion of this two-year study, the annual increase in lumbar adjusted BMD of the group receiving 2 g of SR ranelate was + 2.97 %.
Reginster JY et al. · Curr Pharm Des (2002)
Review written before the phase III results: in cell and animal studies strontium ranelate increased bone-forming activity and inhibited osteoclasts
In a 24-month trial in 160 early postmenopausal women, 1 g/day raised lumbar BMD more than placebo (+1.41% versus 0.98%)
In a 2-year phase II trial in 353 women with vertebral osteoporosis, 2 g/day raised lumbar BMD by 2.97% a year and was associated with a 4% reduction in patients with a new vertebral deformity in the second year
In plain English: These pharmacological and clinical studies suggest that strontium ranelate acts by increasing bone formation and decreasing bone resorption and that these effects result in improved bone mass in vivo.
Marie PJ et al. · Bone (2006)
Mechanistic review: in vitro, strontium ranelate decreased osteoclast differentiation and activity and enhanced preosteoblast replication and collagen synthesis without affecting bone mineralization
In mice and rats it promoted formation, reduced resorption and prevented bone loss after ovariectomy or immobilisation
In the SOTI trial, the formation marker bone alkaline phosphatase rose and the resorption marker CTX fell versus placebo