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📰Read the full Strontium evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ DEXA inflates 10–15% with strontium — not real bone quality [1]
⚠ Ranelate withdrawn for MI/VTE — citrate safety UNKNOWN [1] [2]
⚠ No fracture outcome data for OTC strontium citrate [2]
⚠ Take 2+ hours from calcium (absorption competition) [2]
ℹ️ Not obtained from food. Not applicable — this is not obtained from food in meaningful amounts; supplementation is the practical route.
🔬 Lab interpreter
Recommended test
DEXA (with strontium correction)
DEXA (with strontium correction)
Reference range / target
Improvement (minus 10–15% strontium artifact)
Improvement (minus 10–15% strontium artifact)
MUST account for DEXA inflation [1].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Strontium ranelate (Rx) reduced fractures but was WITHDRAWN for MI/VTE risk. OTC strontium citrate has NO fracture data and UNKNOWN cardiovascular safety. DEXA inflation: 10–15% of measured improvement is ARTIFACT. The safety question is unresolved — patients taking OTC strontium are essentially in an uncontrolled experiment [1] [2].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
AVOID — bone-incorporating heavy metal [1].
👦 Pediatric: See guidance
Not appropriate [1].
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: Bedtime on empty stomach. 2+ hours from calcium [2].
💊 With food: Empty stomach [2].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['Strontium citrate (OTC)', 'common', '680 mg/day. NOT the same as strontium ranelate. Safety data limited [2].'] | Standard | Check label | |
| ['Strontium ranelate (Protelos, Rx)', '', 'WITHDRAWN/restricted in Europe (2014) due to cardiovascular risk [1].'] | Standard | Check label |
3 Common questions
Is strontium citrate safe? ▼
UNKNOWN — the cardiovascular safety concern comes from strontium RANELATE (different salt). Whether strontium citrate carries the same risk is UNSTUDIED. Some argue the ranelate moiety caused the CV risk, not strontium. There is NO safety data for OTC strontium citrate at these doses [2].
Does strontium really improve bone density? ▼
It increases DEXA measurements, but 10–15% of that increase is ARTIFACT from strontium's higher atomic number replacing calcium. Real structural improvement is less than DEXA suggests [1].
Why was Protelos withdrawn? ▼
SOTI/TROPOS trials showed fracture reduction, BUT post-marketing surveillance revealed increased MI and VTE risk. EMA restricted use in 2014, and it was eventually withdrawn in most markets [1].
4 Clinical evidence
Strong
Strontium ranelate reduced vertebral and hip fractures in SOTI and TROPOS trials (Rx). THEN: restricted/withdrawn for increased MI and VTE risk [1]. DEXA inflation: strontium increases measured bone density by 10–15% due to higher atomic number (artifact, not real bone quality improvement) [1]. HIGH
Moderate
OTC strontium citrate: NO fracture outcome data. No cardiovascular safety data. Marketed based on DEXA improvement, which is partly artifact [2]. MODERATE
Insufficient
5 Safety, toxicity & adverse events
Absolute contraindications
✕ (OTC strontium salts) — not for those with the cardiovascular/thromboembolic contraindications that apply to prescription strontium ranelate
Relative
⚠ Interferes with calcium-based bone-density (DXA) readings — inform your clinician
⚠ Renal impairment — reduced clearance
⚠ Take separately from calcium and food
🚩 Red flags
● Patient with cardiovascular disease — ranelate was withdrawn for CV risk; citrate safety unknown [1]
● DEXA improvement = partly artifact (10–15% inflation) [1]
● No fracture prevention data for OTC citrate [2]
6 Interactions
Drug interactions
Calcium Moderate
Mechanism: Absorption competition at same intestinal transporter. [2]
Effect: Reduced strontium absorption. [2]
Action: Separate by 2+ hours [2].
Tetracyclines/quinolones Moderate
Mechanism: Chelation (same as calcium). [1]
Effect: Reduced antibiotic absorption. [1]
Action: Separate by 2+ hours [1].
Supplement synergies
Vitamin D + K2 · Standard doses
If using strontium, ensure adequate D3 and K2 for comprehensive bone support [1].
If using strontium, ensure adequate D3 and K2 for comprehensive bone support [1].
7 Regulatory
Europe (EMA): Strontium ranelate: restricted/withdrawn 2014 [1].
United States: Strontium citrate: dietary supplement (OTC). Never FDA-approved as drug [2].
8 US supplement products
39
on-market products containing Strontium (NIH DSLD)
Brands carrying Strontium (29)
Click a brand to see its Strontium products.
9 Frequently paired with
10 Cite this page
Vancouver: Pkhakadze G. Strontium — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Oct 16]. Available from: https://supplement.ge/ingredients/strontium/
APA 7th: Pkhakadze, G. (2026). Strontium — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/strontium/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: April 2027
References: 2 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Strontium — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/strontium/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG