Strontium Side Effects are Overblown – Get the Facts

Osteoporosis / July 13, 2017

Author: Lara Pizzorno, MDIV, MA, LMT

Lara Pizzorno is the author of “Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life – Naturally” and a member of the American Medical Writers Association with 29 years of experience specializing in bone health . Lara is the Editor of Longevity Medicine Review ( as well as a Senior Medical Editor for SaluGenecists Inc., and Integrative Medicine Advisors, LLC  

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What is Strontium?

Strontium is a mineral from the earth that is naturally found in your body in small amounts.

In fact, 99% of the total amount of strontium in the body is found in bone, a trait it shares with calcium.

Experts now believe strontium is, “an essential trace mineral necessary for the optimal normal development and accretion of peak bone mass, and the sustained health of our bones.”

Along with bone building elements calcium and magnesium, strontium is a member of the elements in Group 2 on The Periodic Table – meaning it shares some similar chemical properties. Strontium is found in varying amounts throughout the world in the soil, and thus in plants grown in the soil, and in the water – so it is a natural part of our diet.

In the U.S., Canada and Europe, the typical diet contains 2–4 mg strontium/day.  However, commercially-produced plant foods grown on fields using synthetic fertilizers, pesticides and herbicides have far lower levels of strontium than their organic counterparts.

Plus, it is well-known that our consumption of plant foods is far below recommended amounts – so it is unlikely you are getting sufficient strontium in your diet.

Consumers of conventionally-grown foods are at risk of strontium deficiency, which, as you will soon see, is a factor that increases our risk of osteopenia/osteoporosis as we age.

However, you may have heard some less-than-confidence inspiring things about strontium. So I’m here to set the record straight…


3 Myths About Strontium

Having reviewed the published research on the different forms of strontium: natural strontium, the strontium ranelate drug, along with the radioactive form of strontium, I can confidently assure you that the natural form of strontium, strontium citrate, is a safe and effective bone health supporter. That goes for both the density and the tensile quality of your bones. (I’ll explain more in detail on how they differ shortly.)

But there are still several misconceptions about strontium citrate pills:

  • Strontium Increases Fracture Risk. Some strontium critics conclude that strontium causes the outer cortical bone to become thicker, reducing tensile strength (resistance to breaking under tension) and increasing the risk of fractures. However, peer-reviewed research shows otherwise.
  • Strontium Supplements Have Side Effects. Strontium has been painted a villain due to undesirable and serious side effects of one form, the drug, strontium ranelate…
  • Strontium Skews DXA Results Too Much To Be Reliable. Since strontium is denser than calcium, it affects bone improvement readings on a DXA scan. So, some question whether strontium is really increasing bone density or if improvements are just a false positive result.

Let’s take a closer, research-based look at each of them. You’ll soon see these misleading statements hold no weight.

But before we do that, it’s important to understand that there are different forms of strontium – and they all do different things…

The 3 Different Types of Strontium Salts You Should Know About

#1 Natural Strontium Salts

The element strontium is present in natural strontium salts.  The most common stable strontium salts are strontium sulfate and strontium carbonate, which are found in soils, and strontium citrate which is used for nutritional supplements.

Stable strontium itself has never been found to cause any harmful effects — with one caveat: to maintain proper balance between calcium and strontium, more calcium than strontium must be consumed.

In more than 100 years of research on strontium, including a number of recent human studies discussed below, no adverse effects have been reported for any natural stable strontium salt when more calcium than strontium is consumed.

Natural strontium salts are safe (at reasonable dosages, of course) and highly beneficial.

Neither of the two forms discussed next are safe.  In fact, each has harmful side effects…

#2 Strontium Ranelate Drug

Strontium’s beneficial effects in the treatment of osteoporosis were reported way back in 1910 — but strontium products never entered the market back then due to confusion between the normal, stable forms of strontium with its radioactive isotopes.  What everyone heard about was radioactive strontium for building atomic bombs – and no company was willing to launch healthful strontium products with public perception as it was.

But more recently, the poor track record and serious side effects of the osteoporosis drugs (the bisphosphonates, denosumab and teriparatide), renewed interest in the bone health benefits of strontium by the French pharmaceutical company, Servier.

Since natural minerals cannot be patented, Servier developed a chemical drug form of strontium called strontium ranelate. Servier now had a patentable, exclusive strontium bone drug which was sold beginning in the early 2000’s under the trade name ProtelosTM.

Ranelic acid is the synthetic compound used to create the unnatural strontium salt, strontium ranelate.

Unfortunately, this drug form of strontium is potentially harmful. For additional sources on its toxicity go to Toxin Profiles and the Agency for Toxic Substances & Disease Registry.

Strontium Ranelate has a long list of adverse side-effects, starting with common ones like:

  • Nausea
  • Skin irritation
  • Fainting
  • Loose Stools
  • Headache

And less common, but possibly deadly effects like:

  • Venous thromboembolism
  • Serious autoimmune reactions, such as DRESS (the acronym for drug rash, eosinophilia and systemic symptoms)

Strontium Ranelate and Blood Clots

Overall, the likelihood that you will be among the ones affected may be small– although a review of the research on strontium ranelate published in 2005 states “Strontium [ranelate] caused a 50% increase in the risk of venous thromboembolism (including pulmonary embolism).”

In the health information provided for medical professionals, Servier, the pharmaceutical company with the patent on strontium ranelate states:

“In Phase III studies, the annual incidence of venous thromboembolism (VTE) observed over 5 years was approximately .7%, with a relative risk of 1.4 in strontium ranelate treated patients as compared to placebo.”

In other words, over a 5-year period in the Phase III studies, each year, 7 of every 1,000 participants taking strontium ranelate developed VTE.

Saying that those taking strontium ranelate had a relative risk for VTE of 1.4 compared to placebo means that strontium ranelate increased risk for VTE by 40%.

Natural strontium citrate has never been found to increase risk of VTE.

Strontium Ranelate and DRESS Syndrome

Another potentially deadly side-effect of taking strontium ranelate is DRESS syndrome.

Symptoms of DRESS syndrome typically begin 1-8 weeks after exposure to the medication. Classic symptoms include widespread rash, fever, and involvement of one or more internal organs.

Approximately 50% of patients will have hepatitis (liver inflammation), 30% will have eosinophilia (high levels of white cells in the blood indicating immune system activation), 10% will have nephritis (inflamed kidneys), and 10% will have pneumonitis (inflamed lungs).

DRESS syndrome is often severe and can result in death if not diagnosed early – for which reason, you’re urged to see your doctor immediately if you develop a rash after taking strontium ranelate.

Another important note:

The use of strontium ranelate has never been approved in the U.S. or Canada and is now significantly restricted in Europe, while strontium citrate is freely available.  

#3 Radioactive Strontium

Radioactive strontium is formed in nuclear reactors or during the explosion of nuclear weapons.

Therapeutically, radioactive strontium is used to treat metastatic cancer but can damage bone marrow and act as a potential carcinogen itself at high doses.

Radioactive strontium isotopes (85Sr and 89 Sr) are also used as delivery agents for chemotherapy drugs and for diagnostic purposes in kinetic studies. (Kinetics is the study of the rate at which chemical processes occur.)  Radioactive strontium is not sold as supplements!

Radioactive strontium, which shows up in imaging and is easily traced, is often substituted for calcium in kinetic research because strontium and calcium behave very much alike in the human body.  

All forms of strontium and calcium have strong bone-seeking properties, and both share common transport pathways, so they compete for absorption in the intestines and for reabsorption in the kidneys.

I want to underscore here that this is a competition that calcium always wins, which explains why:

  • Strontium cannot displace calcium when adequate supplies of calcium are present.
  • Strontium supplements should be taken at a different time of day from calcium, or else little, if any, strontium will be absorbed.

Ok, now that you see the differences in the 3 main types of strontium, let’s dig into the common misconceptions surrounding this valuable mineral.
Strontium Myths

Myth #1: Strontium Increases Fracture Risk

Some strontium critics claim that strontium causes cortical bone to become thicker, and since cortical bone is less flexible, may increase risk of fractures.  

The scientific facts are so different from these assertions, it’s unclear why they publish such misinformation.

The very tiny amount of strontium ions that deposit in our bones prefer to do so in trabecular, not cortical bone.

Trabecular bone is the soft, spongy, more metabolically-active inner portion of our bones. Cortical bone is their hard, outer layer. If your bones were M&Ms, cortical bone would be the outer candy shell and trabecular bone the soft chocolate center.   

cortical vs trabecular bone

Some strontium critics assert that strontium deposits primarily in cortical bone and that somehow translates into reduced bone strength.  

They base their claims on these 2 studies:

  1. Boivin, Deloffre, Perrat, et al.. Strontium distribution and interactions with bone mineral in monkey iliac bone after strontium salt (S 12911) administration. J Bone Miner Res. 1996 Sep;11(9):1302-11. 
  2. Blake and  GM, Fogelman I. (2006 JBMR 21(9) 1417-24 Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy. Clin Interv Aging. 2006;1(4):367-75. 

But in both cases the authors of the studies drew POSITIVE conclusions about strontium’s bone supporting role, yet the uncredentialed author of the website drew negative conclusions!

Here is the researcher’s conclusion for the first study:

“In conclusion, taken up by bone, Strontium … induced no major modifications of the bone mineral at the crystal level. As a result, a treatment with Strontium should not induce any alteration of bone mineral.”

Nowhere in the above study, is it proposed that strontium is weakening bone.

The second study (Blake and Fogelman) drew this conclusion:

“Strontium … is the only treatment proven to be effective at preventing both vertebral and hip fractures in women aged 80 y and over.”

Again, the study says nothing about strontium weakening bone structure. And neither study shows strontium depositing primarily into cortical bone. It doesn’t. Strontium primarily deposits in trabecular bone.

The new-forming bone in the trabecular part of your bones is far more active and incorporates more strontium ions than the cortical bone. Cortical bone also accumulates far more slowly. So its incorporation of strontium – which is less than 1 strontium ion for every 100 calcium ions even in trabecular bone – is even less than cortical bone.

What the research shows is that strontium, in addition to its numerous beneficial effects that boost osteoblast and slow osteoclast activity, also indirectly inhibits resorption of the calcified bone matrix by stabilizing hydroxyapatite crystals.  

Another fact: strontium is the only trace mineral present in human bone whose level in bone correlates with bone compressive strength, i.e., resistance to fracture.

The bottom line is: Strontium citrate improves healthy bone mineralization and resistance to fracture.

Myth #2: Strontium Supplements Have Side Effects

The drug, strontium ranelate, has a long list of side effects, and since the drug has much more media exposure than the health supplement strontium citrate, the two are often confused.

Most blogs, websites, and even doctors do not know that strontium citrate is a completely different molecule from strontium ranelate.  Equating them is like suggesting sodium chloride (table salt) and sodium bicarbonate (baking powder) are the same.  They both contain sodium, but when you connect that sodium molecule to another molecule, its actions are completely different!

Another issue to consider is that the strontium ranelate drug, Protelos, contains Aspartame – an ingredient which is known for causing reactions on its own.  

Natural strontium citrate has never been found to cause any harmful effects– with one caveat: to maintain proper balance between calcium and strontium, more calcium than strontium must be consumed, preferably twice as much calcium.

Myth #3: Strontium Skews DXA Results Too Much To Be Reliable

The common myth is that strontium supplementation results in larger concentrations of strontium in your bones.  And more strontium in your bone causes the DXA to overstate your bone density increase.

The truth is, strontium does weigh much more than calcium, and its mass does impact DXA readings…but only a little.  

Element Atomic Weight
Ca 40.08
Sr 87.63

Strontium has nearly twice the atomic weight of calcium.

Because of this difference in mass, strontium’s substitution for calcium weakens X-ray penetration during DXA scanning and results in overestimation of BMD.  But strontium ions replaces less than one calcium ion out of 10, so the overestimation is not great enough to discount DXA results showing improvements in BMD.

The latest science shows your result may be overstated by 8.5% – 11.2%. But don’t throw the baby out with the bath water.  Even after adjusting your score down by about 10%, an increase in bone density is still an increase!  

For example, if you gained a modest 1% after taking strontium and you reduce that score by 10%, you STILL GAINED .9% of new bone. That’s a big win when you normally would have been losing bone density!

Don’t be fooled by the strontium critics. The increased density in the strontium studies (including the AlgaeCal studies) are still outright increases in bone density in older adults who should be losing bone. And increased bone density is closely correlated with lowered risk of breaking a bone.

Besides, strontium has been shown to reduce fracture risk independent of bone density.  In other words, whether your bone density increases or not, strontium reduces your risk of breaking a bone!

You’ll understand why strontium works as it does when you read the list of strontium’s bone-building effects on both osteoblasts and osteoclasts. (I will be publishing a post on its positive bone-building mechanisms in the near future.)   
woman put effervescent tablet in glass

Deciding on Dosage

How much supplemental strontium do you need for healthy bones?

If you have either osteopenia or osteoporosis, you will receive the most benefit from a 680 milligram per day dose of strontium citrate.

This is the dose that has been used in almost all the human research conducted on stable strontium salts. (It’s also the same dose of strontium citrate provided by 2 capsules of bone-building Strontium Boost.)

If your bones are currently in great shape, you may still wish to consider supplementing with strontium citrate at a dose of 340 milligrams per day. This dose will help protect and maintain the long-term health of your bones.

A personal note: this is my situation. Within a year after I began supplementing with AlgaeCal Plus and Strontium Boost (680 mg strontium citrate daily), my bones were no longer the slightest bit osteopenic. My DXA results were excellent, showing bones in the healthy, normal range, where they have remained, which I credit in large part to taking AlgaeCal Plus, Strontium Boost and, since it became available, Triple Power Omega 3 Fish Oil.

(You can read about my journey from rapidly advancing osteopenia in my early 40s back to healthy bones)

After two years of excellent DXA results, I thought I no longer needed extra help and stopped taking Strontium Boost.

But now, after my in-depth review of the current research on strontium – which involved reading more than 70 recently published papers in the peer-reviewed medical literature – I am convinced that strontium citrate has so much to offer that will help ensure my bones remain healthy that I’ve begun supplementing with Strontium Boost again!

Now, however, I’m taking a prophylactic (preventive) dose of 340 milligrams per day, which I also recommended to my husband to help keep his knees healthy, so, at 69 he can keep playing basketball with men half his age.

What is strontium’s optimal dosage?

In the most recently published studies in which the effects of natural strontium salts on bone health were researched, strontium citrate was effectively absorbed and deposited in bone at both a 340 mg per day and a 680 mg per day dose.  

It should be noted that:

  • The studies showing a 340 mg daily dose of strontium citrate was effective were quite small, including just 10 osteopenic and/or osteoporotic women.
  • Participants in a much larger study in which the 680 mg per day dose was used — 172 women who were followed for a period of 7 years — were taking not only strontium citrate (Strontium Boost), but also AlgaeCal Plus. So, all the credit for the highly significant gains in BMD seen every year — which averaged +1.04% per year over the 7-years — cannot be attributed solely to strontium. However, because strontium is the only mineral that both lowers the rate of bone resorption and promotes the rate at which new bone is built, it’s obvious that strontium contributed to the exceptional results seen in this 7-year study.
  • It’s also vitally important to recognize that THERE IS NO SINGLE MAGIC BONE-BUILDING BULLET! Building bone requires a nutrient “team effort”! Optimal results will be achieved when strontium citrate and ALL the other essential bone-building nutrients are present. These include: calcium; magnesium; boron and 70+ trace minerals; vitamin D3; vitamin K2 (in the form of MK-7); and vitamin C. That’s why you’ll be taking all of these  bone-essentials when you follow the AlgaeCal protocol (thanks to the Bone Builder Pack)

Avoid consuming calcium for at least 2 hours before taking strontium

As explained above, calcium will be preferentially absorbed over strontium. Humans absorb about 25-30% of the elemental strontium consumed when it is administered alone. But if strontium is taken at the same time of calcium, our absorption of strontium is reduced to just 15-18% if it’s taken with calcium. So it’s important that you take the two minerals at least 2 hours apart.

In additional to calcium-containing foods, foods that contain alginate (found in kelp) lower strontium absorption, and so do certain medications, including quinolone antibiotics, and medications that contain aluminum hydroxide or magnesium hydroxide.

For at least 2 hours before and after taking your strontium citrate supplement, avoid consuming:

  • Supplements containing calcium
  • Foods naturally rich in calcium: such as dairy products (cow’s milk, cheese, yogurt, kefir), bone broth, sardines, spinach, kale, collard greens, turnip greens, mustard greens, beet greens, watercress.
  • Foods fortified with calcium: such as calcium-fortified almond, rice and soy milks, tofu, calcium-fortified orange juice and other fruit juices.
  • Kelp: Alginate, which is found in kelp, reduces strontium absorption so greatly that it is used to prevent strontium toxicity in cases of radioactive strontium poisoning.  Alginate is a thickening agent used in sauces, yogurt, puddings and pies.
  • Quinolone antibiotics: like calcium, strontium is likely to form complexes with quinolones in the gastrointestinal tract, preventing absorption of the antibiotic. Broad-spectrum antibiotics, the quinolones include ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), moxifloxacin (Avelox), gatifloxacin (Tequin), and others.
  • Medications that contain calcium: such as calcium-containing antacids and oral tetracyclines. Calcium-containing antacids include calcium carbonate (Tums & others), dihydroxyaluminum sodium carbonate (Rolaids & others). Tetracyclines include demeclocycline (Declomycin), doxycycline (Vibramycin), minocycline (Minocin), and tetracycline (Achromycin, Sumycin).
  • Antacids that contain aluminum hydroxide or magnesium hydroxide: both can reduce absorption of strontium by 20-25%. Antacid medications that contain aluminum or magnesium hydroxide include magaldrate (Riopan), Amphojel, and aluminum hydroxide/magnesium hydroxide combinations (Maalox, Mylanta, others).
  • Chelating agents: It is not uncommon for people over age 50 to have accumulated high levels of heavy metals, such as mercury, cadmium and/or lead. If you have been found to have high levels of heavy metals and have been prescribed an oral chelating agent, such as DMSA, take strontium citrate 3-4 hours before or after consuming your chelating medication.

At this point, you’re probably wondering…
avocado sandwich - when to take strontium

When to Take Strontium Citrate

What schedule can help me optimize strontium absorption and let me lead a normal life? I suggest the following:

  • AlgaeCal Plus: 2 capsules with breakfast
  • AlgaeCal Plus: 2 capsules with lunch
  • Strontium Boost: 2 capsules right before bed (on an empty stomach)

Why this regimen?

It is best to take strontium supplements and calcium at different times of day to get the most benefit.

Take your strontium before bedtime at night. It has been suggested that bone resorption is most active at night, so taking strontium citrate just before bed may result in strontium exerting more of its antiresorptive effects when they are needed most.

Strontium can be taken with or without food. Just be sure the food does not contain calcium.

Calcium on the other hand, should be taken with food so that when food nutrients are being metabolised, the calcium absorption happens along with the other nutrients in the same digestive phase.

Both the strontium and the calcium supplements are absorbed in our gastrointestinal tracts using the same mechanism. Thus, if we take both the supplements together or at the same time, the two will compete for absorption by the body. Scheduling your supplementation like above, will ensure that this does not happen.

What Else Can Be Done To Optimize Strontium Citrate Absorption?

How to boost your ability to absorb strontium and get the most from your strontium supplement…

Our active intestinal absorption of strontium is vitamin D-dependent and decreases with aging, and with consumption of phosphate additives as well as calcium.

You can further optimize your absorption of strontium by:

Ensuring your intake of vitamin D3 is adequate

What’s “adequate” vitamin D3? Sufficient to bring your blood level of 25(OH)D into the 50-80 ng/mL range. 25(OH)D is the vitamin D form circulating in the bloodstream and the marker typically used to assess vitamin D levels. Ask your doctor to get tested to know your current levels and how much you need to bring your levels up to the healthy range.

Avoiding consumption of processed foods

Phosphate, as well as calcium, significantly lowers strontium absorption. Phosphate additives are used as preservatives in most processed foods, including sodas (regular and diet sodas), breads, rolls, sweet bakery products, tortillas, cereals, savory snacks, crackers, snack/meal bars, pizza, poultry, cured meats, vegetables (processed, not fresh!), egg products (e.g., Egg beaters, powdered eggs), seafood, and candy (including chocolate). Read labels!

healthy habit - smelling flowers

Strontium Safety Issues

Individuals with chronic kidney disease

Strontium is eliminated by our kidneys, so it may accumulate in patients with chronic kidney disease, as their kidneys’ ability to filter the blood is compromised.

In patients with chronic renal failure, blood levels of strontium are increased four-fold when creatinine clearance is less than 50 mL/minute. Supplemental strontium should be avoided in individuals with a creatinine clearance less than 50 mL/minute or who are on dialysis. A creatinine clearance rate of 90 or greater indicates normal healthy kidney function. A creatinine clearance rate of 60-89 indicates the initial stage of kidney disease.

Creatinine is a breakdown product of creatine phosphate in muscle; it’s usually produced at a fairly constant rate by the body and is eliminated in urine.  How quickly our kidneys filter creatinine from the bloodstream, which is called the creatinine clearance rate, provides a measure of how effectively your kidneys are filtering your blood. (The creatinine clearance rate is also called the glomerular filtration rate because tiny capillaries in the basic structural and functional unit of the kidney, the nephron, are called glomerular capillaries.)

Bone levels of strontium are often high in chronic kidney disease patients on dialysis

People with chronic kidney disease are less able to remove waste and excess water from the blood. Dialysis is a way of carrying out this process. Dialysis fluid can contain high concentrations of strontium, so not surprisingly, some dialysis patients are known to have elevated bone strontium concentrations and a high strontium/calcium ratio in bone. As a result, about 5% of dialysis patients develop osteomalacia (softening of the bones).  

However, osteomalacia is also frequently seen in end-stage kidney failure patients who are not yet on dialysis and who have normal bone strontium levels. The reasons for this are that failing kidneys lose their ability to:

  • Activate vitamin D (vitamin D is converted into its active, hormonal form in the kidneys –which is the form in which vitamin D helps us absorb calcium from the digestive tract)
  • Re-absorb calcium passing through the kidneys in the bloodstream instead of losing it in urine

So, if you are on dialysis or have end stage of kidney failure, ask your doctor for advice on whether to proceed with strontium supplementation.

Key Takeaways From This Article

  • Strontium delivers a unique combination of bone health benefits no other nutrient provides. Strontium is the only mineral in our bones that both lowers the rate of bone resorption and promotes the rate at which new bone is built.
  • Three types of strontium salts are in use today: (1) Natural stable strontium, e.g., strontium citrate, (2) Unnatural stable pharmaceutical strontium called strontium ranelate, and (3) Radioactive (unstable) strontium.
  • Natural strontium salts, (strontium citrate), are safe (at the dosages discussed above and when twice as much calcium is consumed as strontium) and highly beneficial; neither strontium ranelate nor radioactive (unstable) strontium is safe.
  • Strontium ranelate comes with risks of unwanted side effects. The long list of adverse side-effects attributed to strontium –  ranging from commonly seen adverse effects like nausea and skin irritation to possibly deadly effects like venous thromboembolism and serious autoimmune reactions, such as DRESS – are caused by ranelic acid (the “ranelate” portion of strontium ranelate), not strontium.
  • The use of strontium ranelate has never been approved in the U.S. and is now significantly restricted in Europe, while strontium citrate is freely available.
  • Don’t worry about strontium taking the place of calcium in your bones.  Strontium and calcium share a common carrier system in the intestinal wall, which will always choose to carry calcium rather than strontium from our digestive tract into our bloodstream. Strontium competes with calcium for absorption – and calcium wins every time.  Also, strontium is eliminated more readily than calcium from kidneys.
  • Strontium is almost twice as large as calcium, and its larger size impacts DXA readings. Available data indicate that approximately 10% of the increase seen in BMD is due to strontium’s larger size – which also means that 90% of the increase seen in BMD is accurate.  Besides, strontium has been shown to reduce fracture risk independent of bone density.  In other words, whether your bone density increases or not, strontium reduces your risk of breaking a bone!
  • Strontium’s beneficial effects are not due to its replacing calcium in your bones. They are the result of strontium’s bone-building effects on a very wide range of key molecules involved in bone remodeling.
  • Strontium increases our ability to absorb and deposit calcium in our bones– yes, calcium. And that’s another reason why the Bone Builder Pack of AlgaeCal Plus and Strontium Boost have not only slowed bone loss, but built new bone for the thousands of people who’ve tried it.

Strontium FAQs

The following section answers frequently asked questions about strontium. However, for more detailed answers, please see above.

How much supplemental strontium do you need for healthy bones?

If you have either osteopenia or osteoporosis, you will receive the most benefit from a 680 milligram (mg) per day dose of strontium citrate.  

If your bones are now in great shape, you may still wish to consider supplementing with strontium citrate at a dose of 340mg per day. This dose will help protect and maintain the long-term health of your bones.

When should I take strontium?

Avoid consuming calcium for at least 2 hours before or after taking strontium. Certain foods and medications contain calcium as well as calcium supplements. Ideally, take strontium at night right before bed.

Why do calcium and strontium need to be taken separately?

Calcium and strontium are chemically similar and compete at the same sites for absorption. If you take them at the same time, calcium will out-compete strontium, and you will not get the benefit of strontium.

Is strontium incorporated into bones more readily than calcium?

No. Strontium is not more readily absorbed than calcium. Both minerals use the same transport and absorption mechanisms, and furthermore, calcium will always be preferentially absorbed over strontium. This is why, to receive benefit from supplemental strontium, it should always be taken 3-4 hours apart from when calcium is consumed.  

Could strontium citrate continue to deposit over the years, causing any adverse effect on our bones?  Is there a maximum level of safe strontium in bones?

Although supplemental strontium does continue to become part of the bone matrix for as long as has been studied in the research (5 years), strontium citrate does not negatively affect bone mineralization or bone quality. In fact, strontium improves both. This was a finding from the clinical trials conducted as part of the Ryerson and McMaster University Strontium in Bone Research Study.

All natural, stable forms of strontium improve bone’s ability to undergo physical stress and resist fracture. That’s due to the numerous mechanisms of strontium to build and maintain healthy bones. Strontium increases the amount of osteoblast (remember, bone-building) precursor cells and their differentiation into mature osteoblasts. It also increases collagen type I synthesis and bone matrix mineralization, but inhibits the differentiation, maturation and activity of osteoclasts (bone-resorbing cells).

Furthermore, strontium greatly improves our production of new bone and bone quality via its effects on our osteoblasts and osteoclasts, not by taking the place of calcium in our bones. The number of calcium ions replaced by strontium ions in our bones is extremely small, and remains so because strontium is much more rapidly removed from bone than calcium.

Research conducted for 36 months on human hip bone tissues from postmenopausal osteoporotic women treated with strontium ranelate), found a very small number of calcium ions were replaced by strontium ions in the hydroxyapatite crystals in newly formed bone. It was a strontium substitution of up to one atom in every one hundred calcium atoms being replaced.

However, the thickness and length of the bone mineral crystals were not affected, and there was no indication of a change in human bone tissue quality. Let me repeat, the strontium ions in strontium ranelate exert all strontium’s beneficial effects; the ranelic acid portion is what is responsible for the adverse side-effects seen with this drug.

The only potential for concern with natural strontium supplementation would be IF calcium intake were low, AND strontium intake high. One human study reported an adverse effect from consumption of high levels of natural strontium. That was a paper published in 1996 showing an increased incidence of rickets in children in the Sivas province of Turkey, due to high levels of strontium in the soil AND a low intake of calcium. The recommendation made to prevent this: calcium supplements.

If you are taking AlgaeCal Plus and Strontium Boost, (the Bone Builder Pack) a daily dose of AlgaeCal Plus for bone building is 4 capsules per day, which provides 720 mg of calcium. The Standard American Diet, on average, also provides ~400-600 mg of calcium per day. So total calcium from all sources is anywhere from 1100 – 1300 mg per day. Strontium Boost provides 680 mg of natural strontium citrate per day in 2 capsules. This bone-building combination provides you with twice as much calcium as strontium, which is backed by the research.  

What can I do to optimize strontium supplementation?

You can further boost your ability to absorb strontium and get the most from your strontium supplement if you: (1) Ensure your intake of vitamin D3 is adequate; (2) Avoid consumption of processed foods– all contain phosphate additives, which interfere with strontium absorption.

Is strontium safe?

Yes, the natural, stable strontium salt, strontium citrate, has shown no adverse effects when more calcium than strontium is consumed.

moyra earnshaw

Thank you for these points but you say nothing about the risk of blood clots.

Lara Pizzorno

Hi Moyra,
Sorry, I should have explained that “venous thrombosis” is medical-speak for a blood clot (thrombus) that forms within a vein. “Thrombosis” is the medical term for a blood clot occurring inside any blood vessel. Venous thromboembolism (VTE) refers to life-threatening blood clots in deep veins. If the blood clot lodges in the lungs, it’s called “pulmonary embolism.”
In the section above with the subhead, Adverse Side-effects Are Seen ONLY with Strontium Ranelate – Natural Strontium Salts, Like Strontium Citrate are Safe, I explain that the latest research confirms that strontium ranelate increases risk for VTE. There’s a wee bit of disagreement as to how much — somewhere between 40% and 50%. Easiest if you could please take a look at this section above for the full discussion.

Sheila G.

Hello Laura,

After reading your blog I’m so excited to be trying something natural to improve my osteoporosis and have purchased the Garden of Life Vitamin Code Grow Bone. My concern is that if Strontium Citrate is a “salt” will it raise my blood pressure? I am on a low salt diet to control my blood pressure.

Thank you,


Lara Pizzorno

Hi Sheila,
Strontium citrate is not the kind of “salt” that you are concerned about — this is sodium chloride, which does, if consumed in excess, cause an increase in blood pressure. Virtually all minerals must combine with another organic compound to be stable (e.g., citrate, malate, chloride) These stable compounds are referred to as “salts”. The biochemical reason for this is that minerals each have an ionic charge that must be balanced — in a “salt,” you have a cation and an anion– a positively charged and negatively charged atom or atoms in the mineral and the organic compound with which it combines, that balance each other, so that a stable compound is formed.
To help lower your blood pressure (and build healthy bones), eat lots of mineral (potassium, magnesium, calcium)-rich green leafy vegetables and avoid the unrefrigerated stuff (I refuse to call this “food”) in boxes and cans in the aisles of your grocery store — the processed food-like items. A few, marked low sodium, will be low in salt, but they are also going to be low in all the good things you need to build bones! Also avoid fast foods and most restaurant foods — these are typically loaded with sodium chloride. If you follow the dietary recommendations in Your Bones, you will lower your blood pressure along with your risks for virtually all chronic degenerative diseases, and build healthy bones along with overall good health. BE WELL! Lara


Keep working ,impressive job! abkeeffdkekd

Robert Gouterman

In Laura Pizzorno’s blog , she refers to the excretion of ranelic acid , and questions the non excreted portion. What is the excretion of strontium citrate?

Lara Pizzorno

Hi Robert,
I am so delighted you are here! I did return your call — did you get the message I left for you? Re your question above, best outcome would be if very little of either the strontium or the citrate were excreted. You want both of these to be used inside your body — the strontium, to build bone, and the citrate, to help make your overall pH more alkaline. An acidic pH, which many of us typically have because we eat the standard Western diet, contributes to bone loss. Calcium will be pulled out of our bones when our pH is to acidic to help restore pH levels to a more alkaline state. In contrast, ranelic acid is an unnatural, lately created in a lab, compound, which, the research indicates, increases your risk for venous thromboembolism and DRESS syndrome, among other unpleasant side effects. When it was created, it’s “claim to fame” was that it was supposed to be competely inert, and would just zip through our bodies without doing anything, and it was supposed to be completely excreted. Obviously, this is not the case.


You mention several other bone products such as Boniva, etc. but did not mention Forteo. How does that one compare in your analysis? Thank You

Lara Pizzorno

Hi Lowell,
Great question — in sum, Forteo, used short-term, for men with glucocorticoid-induced severe osteoporosis, is likely worth the risks its use entails. However, I certainly would not take this drug to treat postmenopausal osteoporosis or bone loss caused by the myriad of other factors that contribute to osteoporosis in both men and women, which I discuss in Your Bones.
I believe in going to the peer-reviewed published medical studies to form an opinion. I did so. Here’s a summary of the current research on Forteo.
Forteo (teriparatide) is a portion (amino-terminal fragment) of human parathyroid hormone—the amino acid sequence 1-34. The full molecule of parathyroid hormone (PTH) contains 84 amino acids. PTH regulates calcium and phosphate metabolism in our bones and kidneys. If chronically elevated, PTH depletes bone because, when your blood levels of calcium are too low, PTH increases osteoclast activity, so calcium will be liberated from bone to increase calcium levels in the blood. However, if PTH is elevated intermittently – which is what once daily injections of teriparatide are supposed to do (this drug must be taken as an injection)— osteoblasts get activated more than osteoclasts, so the net effect is increased bone mineral density.
Unfortunately, like all the other drugs, Forteo has a number of side effects including not only nausea, leg cramps and dizziness, but an increased risk of bone tumors and osteosarcoma (bone cancer). I’m going to copy in for you the text from a very recent medical journal article (2011), written by one of the researchers, currently at Stanford, who was involved in the development of teriparatide. Here is the citation for this article: Marcus R. Present at the beginning: a personal reminiscence on the history of teriparatide. Osteoporos Int. 2011 Aug;22(8):2241-8. Epub 2011 Mar 31.
Here is Marcus’ summary of the history of teriparatide:
“The ability of parathyroid glandular extracts to stimulate bone acquisition in rodents was established in the 1920s, but interest in this action lay dormant for almost 50 years until application of contemporary laboratory methods permitted the large-scale production of an amino-terminal fragment of PTH, (1-34) hPTH (teriparatide), which was capable of carrying out all known actions of the full-length (1-84) PTH molecule. In the 1970s, largely stimulated by the efforts of a British pharmacologist, Dr. John Parsons, the scientific community began to revisit these anabolic actions and showed that single daily injections of teriparatide dramatically increased bone mass in several mammalian species and restored bone in oöphorectomized [Lara comment –this means they studied female rats that had their ovaries removed, which instantly transforms them into the rat-equivalent of a postmenopausal women] rats. Shortly thereafter, human studies confirmed a striking increase in trabecular bone mass and showed also that an important part of teriparatide’s action is to increase cortical bone. Eli Lilly and Company conducted a formal registration trial in postmenopausal women with osteoporosis. The unexpected occurrence of osteosarcomas in Fisher 344 rats treated long-term with teriparatide provoked an abrupt cessation of that trial, but ambiguity concerning the relevance of this rat finding to human disease, combined with significant anti-fracture efficacy, led to FDA approval of teriparatide for men and postmenopausal women with osteoporosis “at high risk for fracture” in 2002. Subsequently, teriparatide has been approved also for treatment of patients with glucocorticoid-associated osteoporosis, and papers indicating utility of this agent for dental and orthopedic applications have begun to appear.”

My (Lara) takeaway from this is that even though teriparatide long-term caused osteosarcoma in rats– almost 45% of the rats treated with the drug at the highest-tested dose level developed this aggressive form of bone cancer–FDA approved it anyway, saying whether it would do so in humans was ambiguous/unknown. Since our bones are remodeling throughout our lives, any bone building regimen must be followed long-term, which means Forteo must be taken long-term for meaningful benefit. Treatment with teriparatide is approved by the FDA for a limited duration of 18–24 months, and in many European countries approval is limited to 18 months. To put this in context, teriparatide was initially approved for use in men with glucocorticoid-induced osteoporosis, where short term use might make sense. Now it is being recommended for treatment of postmenopausal osteoporosis as well! I don’t know how you feel about being part of an experiment to see how many humans develop bone cancer from taking this drug, but I am unwilling to participate! Especially when we can have healthy bones for life naturally – as I explain in depth and at length in Your Bones.
Other papers in the peer-reviewed medical literature warn of possible hypercalcemia (high blood levels of calcium), hypercalciuria (abnormally high levels of calcium in the urine, which can damage kidneys & result in kidney stones), and hyperuricemia (abnormally high levels of uric acid in the blood—this predisposes to gout and if very high, kidney failure). Here’s a reference for this: Miller PD. Safety of parathyroid hormone for the treatment of osteoporosis. Curr Osteoporos Rep. 2008 Mar;6(1):12-6.
Prior radiation exposure, another contributor to osteosarcoma, is considered a big red flag. If you have had prior radiation exposure (many X-rays, radiation therapy for cancer), teriparatide is definitely contraindicated for you. (Reference for this: Subbiah V, Madsen VS, Raymond AK, et al. Of mice and men: divergent risks of teriparatide-induced osteosarcoma. Osteoporos Int. 2010 Jun;21(6):1041-5. Epub 2009 Jul 14.)
Also I would be hesitant to abnormally boost my PTH every day since above normal levels of PTH have also been associated with cognitive decline and dementia (Alzheimer’s). The connection is that sustained elevated levels of PTH in the brain increase risk of calcium overloading, which leads to impaired blood flow and brain degeneration. (Reference: Braverman ER, Chen TJ, Chen AL, et al. Age-related increases in parathyroid hormone may be antecedent to both osteoporosis and dementia. Endocr Disord. 2009 Oct 13;9:21.) I discuss PTH in more detail in Your Bones, pp. 90-93.
Hope this helps.


Thank you for your thorough explanation. It sounds pretty scary. My wife has been on Forteo for almost 3 months with some stomach and weakness problems. We thought these might go away but not so far. Part of my original question addresses the effectiveness of Forteo as compared with your calcium and strontium products in strengthening the bones. Which is more effective or has any testing taken place? I appreciate your help……

Lara Pizzorno

Hi Lowell,
Yes, I really understand. It is very challenging to make important health decisions without more hard data. Direct head-to-head comparisons have not been done. Medical studies cost hundreds of thousands of dollars. Our government has not funded, and the pharmaceutical companies certainly have no interest in comparing their products to natural, non-patentable, minerals or a program such as I describe in Your Bones that helps individuals to identify what, specifically, is their cause of excessive bone loss. I do know that AlgaeCal has run two human clinical studies involving hundreds of women — and is in process of completing a third — that indicate, with hard data — that their bone support products are effective in building bone, are more effective than calcium and vitamin D3 alone, and produce no adverse effects. I follow the breaking research on bone health closely. It was after coming across these studies that I contacted AlgaeCal to learn more about their research and products. (These papers are Michalek J, Preuss H, Croft H, et al. Changes in total body bone mineral density following a common bone health plan with two versions of a unique bone health supplement: a comparative effectiveness research study. Nutrition Journal April 2011 (sorry, I do not have the page numbers for this, but it is available via BioMed Central) and Kaats G, Preuss H, Croft H. A Comparative Effectiveness Study of Bone Density Changes in Women Over 40 Following Three Bone Health Plans Containing Variations of the Same Novel Plant-sourced Calcium. International Journal of Medical Sciences 2011; 8(3):180-191. ) What I learned convinced me to switch to using AlgaeCal’s products myself. AlgaeCal’s use of a form of calcium made from live-harvested sea algae from the South American coastline, which naturally contains, not just calcium, but 13 other minerals necessary for bone health, including magnesium, boron, silica, manganese, copper, vanadium and strontium, just makes sense to me. They have also added extra vitamin D3 (although in winter you will likely need more than the 1600mg of D3 provided) and vitamin K2 (MK-7 form) in an amount shown to be effective in the research, and their additional strontium product provides the amount of strontium shown to be effective in studies in a natural, safe form. As I have written elsewhere (in the discussion group on the National Osteoporosis Forum where my book, Your Bones, is recommended — actually, we are now on discussion group #2 as NOF has a time limit. We were running out of time, so participants started a second discussion to keep going), I began using AlgaeCal late last summer. I am due for my next DEXA in about 3 months and should then have personal hard data to confirm–or invalidate-my belief in AlgaeCal’s efficacy.

Marilyn Pinkerton

Lara, I never wanted to tie you up while I was moderating the discussion on NOF, but feel free to ask here. My osteoporosis dexa showed a -2.5 in the hip. I take Symbicort 160 4xday, am working hard on trying to get it down to 160 2x day with 80 2x a day. Also take Synthroid (77). Before starting on Xolair a year ago, I was taking 15 different meds a day to try to control the asthma and had been like that for two years after getting atypical pneumonia. Now am much better, but lost 8 pts in my hips in that two year period and had a -2.5 in hip this last time. I have had 3 allergic reactions to antibiotics, so am careful about what I take. I switched to Algae-Cal after you recommended it. I have been taking only 2-3 a day, and one strontium tablet. I take about 350 mg of magnesium, and 3 tablets of ALTA silica a day, and Vit D3 is 3000, Omega 3 oil. Also still taking the Metagenics Ostera, as it is supposed to help if you take steroids. My PCP ran some blood tests in September at my request, Vit D, 25-Hydroxy was 35.4, my calcium and PCH was 9.3 and 58. Dr. said to increase VitD another 100o and I did. Interesting that my calcium was high and I have never taken calcium supplements until quite recently. (I had read Christopher C. Barr, and followed his advise – no calcium, only magnesium and silica). I found NOF, and actually they did a good job of alarming me. Then I read your book and totally tried to follow your advice. I was cautious about the calcium because of Mr. Barr, and was even more cautious when I found out I was in the higher range with no supplementation. That is troubling to me as do not want to end up with hyper-calcium. I have plaque in my carotid arteries, 20-40% range, I started getting the MK7 with the Algae-Cal, but was already taking some MK-4 drops (5-8 a day). MK-4 was the preferred way to go on NOF before you started posting. Still take at least 5 drops a day. I have read your posts to know you are much more aggressive than this. Am I being foolish to be so conservative – my next DEXA will be in about 4-5 months. I have considered asking my GYN for DHEA, all I take is Estrace internally. I will be 69 this year, and took my share of the old kind of Estrogen. She does the bio-est, but is expensive and scary. You have no fear, I envy that. I take a few protein shakes to get the lactoferrin, eat mostly vegetarian (loved your navy bean receipe), try to keep urine in alkaline range. No cheese, butter, only almond milk – and do take yogurt. Try to follow a plant based diet, not so easy to learn!! Am going to order the cod liver /butter oil unless you advise not to. I have a green smoothie at least 5 days a week with collards or kale. Also planted lettuce and do green salads. I live in Arizona, but lungs keep me inside mostly as air here is dry and very dusty. What should I change for the remaining 5 months. Thank you so much, you give an unbelievable amount of time freely to help people who cannot get this kind of help from their doctor. Am insurance poor, so have to go to conventional doctors. My conventional doctor wanted me to go on Reclast, had never heard of strontium. Anyone reading this who has a great endocrinologist in the Phoenix area, let me know. WHEW, sorry wanted to get it all in. Marilyn

Lara Pizzorno

Hi Marilyn, wow–thanks so much for taking the time to send me such a complete picture of what’s going on with you! I am not a doctor, but I can at least give you some suggestions to look into and discuss with your physician. It is all too true that many MDs are not aware of the research on alternatives to pharmaceuticals.

Two issues seem the most important to me — your lung inflammation and, of course, the high calcium levels. Re the inflammation (which as you know promotes activation of osteoclasts, so we really need to get that down!), and your desire to get off Symbicort as quickly as possible (also a goood idea since glucocorticoids cause osteoporosis–here’s a very recent paper on this if your doctor is not already aware of it –den Uyl D, Bultink IE, Lems WF. Glucocorticoid-induced osteoporosis.Clin Exp Rheumatol. 2011 Sep-Oct;29(5 Suppl 68):S93-8. Epub 2011 Oct 21.) , you might benefit greatly from N-acetyl cysteine–especially if you can have your doctor order it as an inhalation solution of Glutathione [60 mg/mL] + NAC [125 mg/mL] to be taken with a nebulizer — only compounding pharmacies provide this. We use Key Pharmacy here in Washington state (, and we have ordered nebulized NAC for patients with COPD as far away as FLA. It is extremely effective– truly close to miraculous in its healing effects. After a month or two using the nebulizer, many of our patients have been able to just take NAC orally; they are that much better!

Re the high blood calcium, my first thought would be that you need more vitamin K, specifically, K2 as MK-7. As I explain in Your Bones, the research indicates that the MK-4 form of K2 must be taken in 3 doses of 15 millligrams each spread throughout the day — in the studies, the dosage schedule was every 6-8 hours. The reason for this is that MK-4 is very quickly metabolized, so it is gone within 6-8 hours. In contrast, the MK-7 form remains bioactive in the body for about 3 days — this is one of the key reasons why you need so much less — just 120 mcg has been shown in the research to be effective — for MOST people. I, personally, am not one of them. I need more than this because I need more vitamin D3, so I take at least 240 mcg of MK-7 daily. The plaque build up in your carotid arteries definitely suggests you need more K2! I feel this is safe — unless a person is on Coumadin/warfarin in which case you must consult with your doctor to help you manage your drug dose so you can gradually increase your vit K without disturbing your INR — because studies have been done showing that even much higher doses of MK-7 (over 800 mcg/day) not only caused no adverse effects but resulted in higher levels of activated osteocalcin. Remember that vit K2 activates a number of important proteins related to calcium regulation in the body — the 2 of most interest for you are osteocalcin, which is involved in putting calcium into bone, and Matrix Gla protein, which keeps calcium out of arteries, kidneys, breasts, etc. There is a still cutting edge but available blood test to check to see how well you are doing at this — they can check your blood levels of uncarboxylated osteocalcin (ucOC). If they are high, this means you are not getting enough vit K2 to activate your osteocalcin and Matrix Gla protein. The test is pricey and will not be covered by your insurance, so I would suggest you look into simply taking additional MK-7 – I use Life Extension’s Super K with Advanced K2 Complex and take 1 capsule AM and 1 capsule PM. Plus I am getting MK-7 in my multiple as well. Here is a link to a review of the research I very recently wrote for Longevity Medicine Review (it’s written for physicians, but you will get the gist of it — and you may wish to suggest your doctor read it, so she or he will be aware of the latest findings in the peer-reviewed medical literature —

Re your vitamin D levels, which your last blood test showed were too low (you want to be between 60-80 ng/mL), since you are lucky enough to be living in the Phoenix area, — if you are not already doing this — please get outside for at least a half hour sometime between 12pm and 2pm and get some sunshine on your skin (no sunscreen!). You can wear a hat and put sunscreen on your face to prevent wrinkling and age spots, but leave at least your arms and legs bare and sunbathe. If even after taking 4,000 IU per day and getting some sun for a couple of months, you are still not in the 60-80 ng/mL range, your genetic inheritance may — like mine — have resulted in poor absorption of vitmain D, so that you need more than the typical person. Please have another blood test run to check you vitamin D levels in another 2 months.
I will look into recommendations for a good endocrinologist in Phoenix. You might check with Martha Grout, MD. She is in Scottsdale, here’s a link to her website. I do not know her personally, but she is a member of the Institute for Functional Medicine –a very good sign, the doctors involved with the IFM are both better informed and more open to integrative medicine. She may know of me, but will certainly know of my husband, Dr. Joe Pizzorno–he has been on the IFM board for 20+ years, is one of their Linus Pauling Award recipients, and served as Chair of the IFM Board for a number of years. Here s a link to Dr. Grout’s website:
Re being insurance poor – I am hoping that Dr. Grout will still be able to be helpful. I cannot know your financial situation, but nothing is as important as your health. Please consider investing in your health if you possibly can.
Lastly, re bio-identical hormone replacement. I am on BHRT myself–have been for about 10 years now — and I believe this would also be very helpful for you. Dr. Grout does offer BHRT. To learn more, you could read Dr. Wright’s excellent book about it — explains absolutely everything you need to know about BHRT. Has a horrible title, though – Stay Young & Sexy with BHRT (Smart Publications — )
Please keep me posted on how you are doing. And don’t hesitate to get in touch if I can be helpful.

Marilyn Pinkerton

Thanks Lara. I reread my post this morning before I read yours. I should have been
.8 in reference to the bone density drop, but sure you figured that out. I was concerned the 9.3 calcium was at the high end of normal, but am more concerned that you think it is high. Will definitely not eat any more yogurt as that was just a sugar splurge. So are you comfortable with me taking 2 of the AlgaeCal daily as I was hoping to up by strontium to 2 daily. With my steroid issues, do you think the strontium is my best hope. I had read about the doctor you mentioned, as I have searched high and low for someone. Would love to find a Bastry U. grad here that you guys knew. I do get MK-7 in the Algae-Cal, should I supplement 50mg more. The MK-4 that I take is such a small dose, that should be OK, right .
Sorry, do not mean to hammer on you with questions. Thank you for all your help, will run that info by the allergist, and also check with GYN-possibly DHEA could help. Making collards and beans today! As always, grateful to you! Marilyn

Marilyn Pinkerton

Sorry, used to the post preview at NOH, lots of booboos! M

Lara Pizzorno

Hi Marilyn,
No worries! Please do not be overly concerned about having a calcium at high end of normal — remember, you are still within the normal range. Everyone is different, so high end of normal may be normal for your body. Nonethelss, I believe this may indicate suboptimal vitamin K2 status, plus many studies have now demonstrated that vitamin K (and specifically K2) is needed for healthy bones and to prevent calcification of arteries and other soft tissues. So, yes, I would take more vitamin K2. Vitamin K2 (MK-7) at a dose of 120 mcg/day or even 240 mcg/day is extremely safe. No studies have shown any adverse effects. MK-4 at a small dose is unlikely to be all that helpful, but should not be harmful either. The only caveat here is if you are on Coumadin/warfarin, in which case you need to work with your doctor to stablize your INR when taking vitamin K.
Yogurt is a healthful food supplying healthy intestinal bacteria as well as calcium. Enjoying a cup of yogurt will be good for you and your bones, unless you are allergic to dairy products, in which case, consuming dairy foods will increase inflammation in your body, and inflammation activates osteoclasts, so not good! You could try soy yogurt instead.
Strontium citrate is also very safe, again, no adverse effects have been seen with natural forms of strontium (ie strontium citrate) if more calcium is being consumed than strontium. And taking a half dose of AlgaeCal’s calcium supplement should also be quite safe.
Yes, DHEA supplementation is a very good idea. The decline in DHEA, which is produced by our adrenals & thus not related to menopause at all, can start as early as the late 20s, and research has proven that our levels of DHEA correlate with BMD — in both pre- and postmenopausal women. Dr. Wright discusses this in Stay Young & Sexy with BHRT. In one of the studies he notes, women with the lowest levels of DHEA had double the risk of fracture as women with the highest levels. (Garnero P et al. J Bone Miner Res 2000;15:1526-36.) I took a look on PubMed to check for the most recent papers found a number of others confirming this association. The most recent study showed higher levels of DHEA were associated with 0.49% less bone loss at the neck of the femur (Ghebre MA, Hart DJ, Hakim AJ, et al. Association between DHEAS and bone loss in postmenopausal women: a 15-year longitudinal population-based study. Calcif Tissue Int. 2011 Oct;89(4):295-302.PMID: 21789637) The only potential issue here is that DHEA is an androgen and a precursor to testosterone, so taking too much DHEA (for YOU) can cause the appearance of secondary male sexual characteristics in women – e.g., acne, growth of excess body and facial hair, loss of scalp hair. Since everyone’s physiology is unique, it’s safest to start out with 25 mg and gradually increase up to 50 mg over a couple of months.
Given your allergies, my best recommendation for you is to work with a knowledgeable physician who can run the tests needed to monitor precisely what is happening in YOUR body. Joe took a look to see who is in Arizona near Phoenix, and discovered that one of the contributors to the Textbook of Natural Medicine, Dr. Tom Kruzell, ND, is in Scottsdale! He’s not a Bastyr grad, but Joe recommends him; he is a very good doctor. His phone number is 480-767-7119. His website is Keep me posted on how you are doing and don’t hesitate to get in touch if I can be helpful.

Marilyn Pinkerton

Lara, Thank you seems so inadequate. Thank Dr. Joe also for his recommendation. Reading your book and following all your posts has really helped me. God Bless, Marilyn

Tammye Herring

Hi Lara,

When referring to the SOTI and TROPOS trials, you used the term “strontium” but didn’t specify “ranelate” or “citrate,” unless I just totally missed it. Can you clarify which type of strontium was used in these trials?

Thanks much,

Lara Pizzorno

Hi Tammye,
Strontium ranelate was used in these trials. Medical research is VERY expensive, so the drug companies are not going to spend the money on something they cannot patent and make a big profit on. Because strontium ranelate, not strontium citrate or other natural strontium salt was used in SOTI and TROPOS, that’s why although BMD improved and fracture rates dropped, a few unfortunate individuals experienced a number of side effects, including very serious ones, i.e., venous thromboembolism and DRESS syndrome. Most of the recent research on strontium has been done on strontium ranelate because it is patentable by a drug company since it is a combination of strontium plus ranelic acid — a molecule never before seen on planet Earth and therefore patentable. Strontium is what is responsible for the bone-building effects. Ranelic acid was created to make it patentable. Since a significant amount of other research over the last 40 years has never shown any adverse effects from strontium combined with natural salts, like citrate (unless way more strontium was being consumed than calcium and then the adverse effect was rickets, not VTE or DRESS syndrome), it is only rational to conclude that the cause of the ADRs is the new-to-nature ranelic acid (ranelate in the combo). I hope this answers your question — I realize I sound like a broken record here, but the point is that even though SOTI and TROPOS showed beneficial effects on bone from strontium ranelate, we can have these benefits using a natural form of strontium (like strontium citrate) without the health risks (and high financial costs) of taking the patent medication.


Hi Lara,
I read your research about the strontium ranelate vs. sc.from a post in 2010. It was very informative. However, I’ve been curious about taking calcium microcrystailine hydroxiapetite as a calcium source to increase my BMD .Everything I read is good about this form of calcium, and that it is the closest to the calcium we use to produce bone. I was diagnosed with osteoporosis in July of 2009. I’m leery of the strontium “replacing” calcium in my bones, where calcium is what is supposed to be forming bones, not strontium. I have not added the MCHC to my regimen yet.

Anne Clemens

I have been on the AlgaeCal program for a year, and after reading some commentary, I would like clarification on the best way to take the strontium. I have been taking it around 10 pm, which is at least 3 hours after dinner and a fruit dessert with plain yogurt. At the same time I take tamoxifen as follow-up to my breast cancer surgery. Because I also have acid reflux, I have taken 1/2 banana or a cracker along with the pills. Is this a mistake? Is it important to take the strontium on an empty stomach?

Lara Pizzorno

Hi Anne, what you are doing sounds great. No need to take strontium on an empty stomach. You just want to take strontium at a time when you are not also consuming calcium since the two minerals compete for absorption (and calcium always wins, so you will get little benefit from your strontium if you take it when also consuming calcium). But 3 hours afer eating a bit of yogurt as part of a fruit dessert should not be an issue. Within 3 hours, you will have digested the yogurt and absorbed the calcium in it.

Carleen Buschmann

I had breast cancer. I have osteoporosis causes by chemo and Letrozole so I stitch Letrozole to Tamoxifen. I will order algae cal. Which one is the best to take strontium? Strontium citrate?
Can I take algae cal and strontium with meal?


Lara Pizzorno

Hello Carleen,

The form of strontium you should consider taking is strontium citrate — NOT strontium ranelate–this form has caused many adverse effects, which I have written about — at length — both in my book Your Bones, 2nd edition and on AlgaeCal’s blog.

You should be taking both AlgaeCal Plus and their strontium product, which is called Strontium Boost (and which is strontium citrate).

You can take either AlgaeCal Plus or Strontium Boost with a meal. However, you must take Strontium either without food or if with a meal, it should be a meal that does not contain calcium. Calcium and strontium compete for absorption, and calcium always wins, so you will not get benefit from the strontium if taken with calcium.
For the same reason. Do not take AlgaeCal Plus and Strontium Boost at the same time.

Hope this helps,

nina Poulsson


I have been treated for Multiple Myelome that spread to the bones. I get Zometa once a month. I need some good Calcium products to build up my bones in addition to Zometa and I am also doing a lot of exercise. Will AlgaeCal Plus and Strontium Boost be good for me to take?


Lara Pizzorno

Hi Nina,

I can give you some information that I hope will be helpful to you, but you will need to check with your oncologist on this.

As you most likely already know, the excessive bone loss that occurs with myeloma happens because the cancerous white blood cells accumulate in the marrow within bones, which react by increasing their expression of RANKL (Receptor Activator for Nuclear Factor kappa-B Ligand). RANKL activates osteoclasts, which are one of the types of cells present in bone marrow, and the osteoclasts then go about their job of breaking down bone. One result of this excessive osteoclast activity is that when bone is broken down, calcium is released into the blood, and this can lead to too much calcium in the bloodstream, for which the medical term is “hypercalcemia”. Hypercalcemia is a serious condition that can result in abnormal heart rhythms, heart attack, kidney or gallbladder stones, depression, cognitive dysfunction, and coma — you definitely want to be sure whatever you are doing is not going to further increase your blood levels of calcium! So, although AlgaeCal Plus is an excellent, highly bioavailable calcium (and other nutrients required for bone-building) product, for YOU, calcium supplements, no matter how good they are, may not be a good idea. On the other hand, some research (which I mention below) does suggest calcium supplementation can be helpful. Bottom line here –you must discuss this with your doctor. IF your doctor believes calcium supplementation will be good for YOU, then I highly recommend AlgaeCal, which will not only provide easily aborbed and utilized calcium but a number of other key bone-building nutrients.

AlgaeCal’s Strontium product could be very helpful for YOU and should be safe. Strontium is incoroporated into bone similarly to calcium and improves bone density and quality, providing significant bone strengthening benefits. Your doctor is likely aware of the research on the patented (drug) form of strontium — strontium ranelate. The natural form of strontium available as a supplement, strontium citrate (this is the form of strontium in AlgaeCal’s Strontium Boost product) has none of the adverse effects the research has shown may occur with strontium ranelate (blood clots & DRESS syndrome are the two worst). Strontium citrate is just as effective in building bone as strontium ranelate (not surprising, since it’s the strontium doing the helpful work). Also, YOU should not be taking strontium ranelate because individuals with hematologic malignancies (which include multiple myeloma) are already at increased risk for venous thromboembolism (the deep vein blood clots for which strontium ranelate has been shown to increase risk –your doctor probably already knows this, but just in case, here’s a citation for a recent paper on PubMed about this issue: Chong BH, Lee SH. Management of thromboembolism in hematologic malignancies. Semin Thromb Hemost. 2007 Jun;33(4):435-48. PMID: 17525901.

Other nutrients that may be especially helpful for YOU include vitamin D3 (if you have not already had your blood levels of 25(OH)D checked [this is the circulating form of vitamin D and the best indicator of body stores], please ask your doctor to do so) and vitamin K2 (the MK-7 form).

How much vitamin D3 YOU need will depend on what your blood levels currently are, also you will need to discuss vitamin D supplementation with your physician because among its many activities, vitamin D increases your body’s ability to absorb calcium. However, low vitamin D levels are associated with poorer prognosis in individuals with multiple myeloma (Here’s a reference on this: Ng AC, Kumar SK, Rajkumar SV, Drake MT. Impact of vitamin D deficiency on the clinical presentation and prognosis of patients with newly diagnosed multiple myeloma. Am J Hematol. 2009 Jul;84(7):397-400. PMID: 19415724)
Another recent paper your doctor may not be aware of helps to explain why having low vitamin D contributes to disease progression in multiple myeloma. This is a paper by Dr. Michael Holick, one of the leading vitamin D researchers in the world. Dr. Holick believes vitamin D insufficiency contributes significantly to multiple myeloma — here is part of what he says about this: “The consequence of vitamin D deficiency on the skeleton is two-fold. The secondary hyperparathyroidism induced by vitamin D deficiency will increase the number of osteoclasts, causing the removal of mineral and matrix from the skeleton, which can result in osteopenia and osteoporosis. The secondary hyperparathyroidism also causes phosphaturia, resulting in an inadequate calcium-phosphate product in the circulation, leading to a defect in the mineralization of newly laid down osteoid, causing osteomalacia.” What this means in English is that if you have low levels of vitamin D, this will promote hyperparathyroidism (overproduction of parathyroid hormone). Parathyroid hormone increases osteoclast activity & the osteoclasts break down bone, which increases blood levels of calcium. Too much parathyroid hormone also disrupts the way calcium and other minerals are in laid down in making new bone and this results in osteomalacia, which is the medical term for bone pain. (Here’s the reference for this paper: (Here’s the reference: Holick MF. Multiple myeloma and cancer: is there a D-lightful connection? Am J Hematol. 2009 Jul;84(7):393-4. PMID: 19507212)

Vitamin K2 is also likely going to be very important for you because K2 activates the proteins whose job it is to keep calcium out of your arteries (this protein is called Matrix Gla-Protein) and put it into your bones (this protein is called osteocalcin). Also, some research (albeit test tube studies, not in humans) shows K2 both inhibits the development of multiple myeloma cells and causes these cancer cells to self-destruct. (Here’s the reference for this: Tsujioka T, Miura Y, Otsuki T, et al. The mechanisms of vitamin K2-induced apoptosis of myeloma cells. Haematologica. 2006 May;91(5):613-9. PMID: 16670066)

Lastly, you might also discuss using Prolia (denosumab) rather than Zometa (an IV bisphosphonate) with your oncologist. Prolia specifically inhibits RANKL and has been found to be more effective than Zometa in cancer patients. For these reasons, it might be a better option for you. Here are two recent papers on this for you to share with your doctor:
(1) Lipton A, Jacobs I. Denosumab: benefits of RANK ligand inhibition in cancer patients. Curr Opin Support Palliat Care. 2011 Sep;5(3):258-64. PMID: 21826000 Key copy from this paper: ” “Pivotal clinical trial data with denosumab in advanced cancer patients across tumor types showed it was superior (breast and prostate) or noninferior trending toward superior (solid tumors/multiple myeloma) to zoledronic acid, in reducing the risk of developing an SRE [skeletal related event] and demonstrated a favorable safety profile. Denosumab has also demonstrated efficacy in the treatment of giant cell tumor of bone. Denosumab offers an important new treatment option for patients with solid tumors and bone metastases.”

(2) Henry DH, Costa L, Goldwasser F, et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol. 2011 Mar 20;29(9):1125-32. Epub 2011 Feb 22. PMID: 21343556.
This study compared denosumab (Prolia) with zoledronic acid (Zometa) for delaying or preventing skeletal-related events (fracture, spinal compression) in patients with advanced cancer and bone metastases (excluding breast and prostate) or myeloma. Patients were randomly assigned to receive monthly injection of denosumab 120 mg or IV zoledronic acid 4 mg (in patients with kidney problems, the dose had to be adjusted). Daily supplemental calcium and vitamin D were strongly recommended, which makes me think that AlgaeCal Plus may be helpful for you. The primary end point was time to first “skeletal related event.” Denosumab was as effective as zoledronic acid, slightly better in preventing or delaying first on-study “skeletal-related event” in patients with advanced cancer metastatic to bone or myeloma. Denosumab is more convenient (injection vs IV) and unlike Zometa, does not require that patients be monitored for possible kidney damage (for which Zometa must be monitored).

Nina, I so admire you for seeking out the best options for your recovery and for your commitment to getting lots of exercise, which certainly will help in your healing and hopefully be fun for you as well. If I can be of further help to you, please don’t hesitate to ask. Be well! Lara

Jane Sothcott

Good morning,

I have been so impressed with the information regarding Strontium Citrate in your blog. I am however still slightly confused regarding side effects. Here in the UK Strontium Ranelate is available on prescription and since I am contra-indicated for all bisphosphonates I was really hoping to be offered Protelos. However I have discovered that I will not now be offered this medication due to the fact that 15 years ago I suffered a pulmonary embolism post surgery. I have had no further problems. Whilst I appreciate you cannot offer medical advice can you point me in the direction of any research to indicate that Strontium Citrate as a supplement would be suitable for me. I have seen advertisements on other sites for Strontium Citrate but these have carried warnings about blood clots and kidney disease whilst the algaecal version does not.

Thanking you in anticipation of your kind response.

Kindest regards.


Lara Pizzorno

Hi Jane,
Delighted you found the blog helpful. Re strontium citrate — not a single study has ever shown that strontium citrate causes venous thromboembolism (VTE) or any blood clots or DRESS syndrome. Only strontium ranelate has been found to produce these adverse effects. At the bottom of the blog is a link that says “Show References” — just click on this and a list of all the studies noted in the blog will appear for you. The references are provided in the order in which they are cited in the blog — each footnote in the blog is referenced to a study in the peer-reviewed medical literature accessible via PubMed. These include the most important studies done over the last century on strontium citrate, all of which validate its safety — no adverse effects of any kind when taken in amounts approximately half those of calcium being consumed. The references also include, in contrast, the latest research indicating strontium ranelate is clearly associated with VTE, DRESS, and a number of other adverse effects. The latest review of the evidence confirming strontium ranelate may produce potentially lethal adverse effects has just been published in Prescrire International, March 21, 2012, so had not yet been published when I wrote the blog and is therefore not included in my list of references. The title of this review? “Strontium ranelate: too many adverse effects: Do not use”. Prescrire International is a non-profit organization which publishes a PubMed accepted journal and has, for the last 30 years, provided health care professionals with reliable information about drugs and therapeutic strategies. is Here’s the full citation on this paper–Strontium ranelate: too many adverse effects (continued) Do not use. Prescrire Int. 2012 Mar;21(125):72. PMID: 22428195 ) Here’s a link to the new issue of Prescrire Int in which this study is published:
Unfortunately, your “health” insurance will not cover natural, safe strontium citrate — just the patented drug, strontium ranelate. Please complain! If enough people ask for it, perhaps your NHS will cover strontium citrate.

Jane Sothcott

Good Morning Lara,

Thank you so much for your prompt and comprehensive reply. You have given me hope and courage to become more pro-active in my dealings with osteoporosis. I have seen my GP this morning and explained my frustration and sadness at almost being made to feel untreatable. She actually listened and heard my voice and whilst unable to prescribe has taken the literature I offered and will read up on the subject. She has booked me in for blood tests for calcium, VitD and Magnesium and made an appointment to see the dietician regarding an alkaline diet. Previous blood tests have shown extremely poor levels of VitD and I had been prescribed a calcium/vitD supplement. She is happy for me to start on the Strontium Citrate but wants to wait untill the blood results are in to determine which amounts of calcium and vitD I need supplementally. I also understand there are other supplements recommended and will, I am sure come back to you for advice on those. I can’t thank you enough. I feel that a new day is beginning for me on this journey. Bless you.


Lara Pizzorno

Hi Jane,
You are so welcome! Please also check with your doctor regarding vitamin K2. Vitamin D will increase your body’s ability to absorb calcium — vitamin D will NOT ensure that your body puts that calcium where you want it to go — into your bones. For this you need adequate levels of vitamin K2. Vitamin K2 activates the protein responsible for moving calcium into bone (which is called osteocalcin) AND the protein responsible for keeping calcium from depositing in your arteries, kidneys, breasts, etc. (which is called matrix Gla protein). I’ve written quite a bit about K2 — both for doctors on Longevity Medicine Review (here’s a link to the most recent review on K2:
and for the public in Your Bones pp. 141-153.
Jane, I am certain that by supplying your bones with the nutrients they need to rebuild along with a little daily weight bearing exercise, you can restore their health naturally and safely. I’m copying here for you what I recently posted in my blog on Prolia about the COMB study in hopes it will — with good reason — give you confidence in your ability to restore your bones’ health naturally:
Just last month (February 2012), right after the annual meeting of the American Academy of Orthopaedic Surgeons officially warned doctors that the bisphosphonates increase risk for “atypical femur fractures,”[xii] the results of the one-year long Combination of Micronutrients for Bone (COMB) Study were published in the prestigious Journal of Environmental and Public Health. The COMB study unequivocally demonstrated that providing our bones with the nutrients they need along with regular weight-bearing exercise is as or more effective than any of the bisphosphonates or strontium ranelate (the unnatural drug version of strontium). And a lot less expensive!

What was the protocol utilized in the COMB Study? Daily vitamin D3 (2,000 IU), DHA (250 mg), K2 (in the form of MK-7, 100 mcg), strontium citrate (680 mg), magnesium (25 mg), and dietary calcium. In addition, daily impact exercise was encouraged.[xiii]

As one of the lead researchers, aptly named Dr. Stephen Genius, noted, not only was this combination of nutrients that bones require “at least as effective as bisphosphonates or strontium ranelate in raising BMD levels in hip, spine, and femoral neck sites,” but the nutrient supplement regimen was also effective “in individuals where bisphosphonate therapy was previously unsuccessful in maintaining or raising BMD.”

What a concept – by providing our bodies with the nutrients our bones require and enjoying a little weight-bearing exercise, we can build strong bones for life, safely, effectively – naturally! If you are taking AlgaeCal Plus and Strontium Boost, you’ll more than match the nutrient levels provided in the COMB study. All you need to add to your bone building program to mimic the COMB recommendations is some daily, weight-bearing exercise.


Hi Lara, Note that the COMB study was conducted by Dr. GenUIs (not Genius)…I have contacted his office regarding the type of exercise that was used by patients in the study and was surprised to learn that he recommends “jumping, running, or jogging” (exercises that are typically contraindicated for osteoporotic patients as per, working up to 300 repetitions. I also questioned the administration of the strontium citrate and was told that “the strontium is taken as a single dose and no restriction is provided as to when the supplements are taken.” What are your thoughts about these recommendations?


hi lara… idont knowif my email will reach you… what does the website refers to? any way if it does and i hope it will i want to thank and congratulate you on the
excellent responses to queries… i would like to know in what dosages do one has to
take strontium citrate and calsium ect.. i changed to strontium citrate [ costs about a third of ranelate]about 3months ago after being on ranelate for 5years.. i had a bmd in january and it showed a small improvement which i am grateful for… i`m 63yrs and excited to see next year`s results… i am changing my calsium from Biogen Calmag Max Absorption[with120ug K2 ect to Real Thing Bone Revolution an organic sea veg calsium mineral mix these products we get in south africa.. further i take everthing in stride,,, had a couple of falls with no fractures …perhaps i`m just lucky referring to other letters of people having a lot of fractures… nice writing to you… forgive the errors, english is my second language… regards.. patricia

Lara Pizzorno

Hi Patricia,
Yes, your email arrived, although I don’t see it posted here in the Comments section yet, so I will copy in and respond to your questions here. Your English is very good!:

” i would like to know in what dosages do one has to take strontium citrate and calcium ect.. i changed to strontium citrate [ costs about a third of ranelate]about 3 months ago after being on ranelate for 5years.. i had a bmd in january and it showed a small improvement which i am grateful for… i`m 63yrs and excited to see next year`s results… i am changing my calcium from Biogen Calmag Max Absorption[with120ug K2 ect to Real Thing Bone Revolution an organic sea veg calsium mineral mix these products we get in south africa.. further i take everthing in stride,,, had a couple of falls with no fractures …perhaps i`m just lucky referring to other letters of people having a lot of fractures… nice writing to you… forgive the errors, english is my second language… regards.. patricia”

Here’s my reply:
The research indicates a daily supplemental doses of 680 mg of strontium citrate and 1,200 mg of calcium are effective. Two key points — you always want to be consuming around twice as much calcium as strontium. If you are not allergic to dairy foods, then I expect you are likely getting at least several hundred milligrams of calcium from milk, cheese, yogurt, kefir, etc. Even if you are avoiding dairy products, if you are eating lots of dark green leafy vegetables you will be getting calcium from these as well. ( I hope you are eating lots of these vegetables — like spinach, kale, Swiss chard, broccoli — because they contain not only calcium but other minerals and vitamins essential for building healthy bones (e.g., vitamin K1, magnesium, boron). And they are very good sources of calcium — spinach, for example, contains 245 mg in a 1 cup serving!
Secondly, take your strontium at a different time of day from when you are consuming calcium. Strontium and calcium compete and calcium always wins — so to get the most benefit from your strontium, take it at least 2 hours before or after having calcium supplements or foods rich in calcium.

Delighted to learn you are taking an organic sea vegetable derived calcium-mineral mix and that this is available in South Africa! From the research I have seen on algae-derived calcium, it is more bioavailable and more effectively used in building bone than calcium derived from rock.

Regarding your falls — two things to consider — weight-bearing exercise and vitamin D3. Both have been shown in the research to significantly lessen risk of falling (and thus of fractures).
LOTS of research re vit D helping to prevent falls – here’s a quote from just one of the most recent papers: “Discussion Vitamin D supplementation can prevent falls, particularly in the vitamin D deficient elderly.” (Reference: Winzenberg T, van der Mei I, Mason RS, et al. Vitamin D and the musculoskeletal health of older adults.Aust Fam Physician. 2012 Mar;41(3):92-9.PMID: 22396920)
In fact, there has been so much research indicating vit D plays a very important role in our muscular stability that two very large trials are now in progress to sort out the best specific recommendations for how much vit D and how much calcium is optimal — here are two papers discussing these studies — one is being conducted in Spain, the other in Finland:
López-Torres Hidalgo J; ANVITAD Group.Prevention of falls and fractures in old people by administration of calcium and vitamin D. randomized clinical trial.BMC Public Health. 2011 Dec 9;11:910.PMID: 22151975
Uusi-Rasi K, Kannus P, Karinkanta S, et al. Study protocol for prevention of falls: A randomized controlled trial of effects of vitamin D and exercise on falls prevention.BMC Geriatr. 2012 Mar 26;12(1):12. [Epub ahead of print]PMID: 22448872
So, are you taking vitamin D3? If so, have you had your blood levels of 25(OH)D checked? This is the best indicator of body levels of vitamin D. Optimal levels are now said in the latest medical journal papers to be between 60-80 ng/mL. Many people need 5,000 IU of vit D3 daily to achieve these levels.

Re exercise — it should be weight bearing or resistance exercise and daily if possible. Take a half-hour walk (at least some of it up hill or walking up stairs), go dancing, lift weights and do squats. I do Pilates daily myself and also lift weights and take a dance type aerobic class called Zumba a couple of times each week. I keep trying to convince my husband to go dancing but no success — yet.
Here’s just one of many medical journal articles discussing the benefits of regular weight bearing exercise on preventing falls: Robitaille Y, Laforest S, Fournier M, et al. Moving forward in fall prevention: an intervention to improve balance among older adults in real-world settings. Am J Public Health. 2005 Nov;95(11):2049-56. Epub 2005 Sep 29.PMID: 16195514
I’m 63 years old, too — isn’t is great how much fun it is to be “all grown up” now that we can stay strong and healthy! We are so fortunate to have access to the discoveries in the medical research about what our bodies need to remain healthy — many of these insights have only surfaced during the last 25 years. We’ve come a very long way since vitamins were “discovered” 100 years ago!
My husband, Dr. Joe Pizzorno, and I have a great friend in South Africa, Dr. Myron Schultz, D.C.–he’s in Durbin at the University. We keep hoping to have a chance to come visit him and see your lovely country.
Stay well! Lara


I am constantly on the lookout for additional information regarding strontium citrate. I, therefore, thank you for all this valuable information. I have two regarding your recommended daily dosage for strontium and the second regarding your recommended daily dosage for Vitamin K4. Recently I have cut back on my dosage of strontium citrate from 680 mg daily to 1 tablet of 340 mg daily. In addition I take 5 mg of Vitamin K4 (menatetrenone). Also (I guess this is a 3rd question) how long do you recommend that someone should stay on these two vitamins (i.e. how many years)?
I’m not sure where I should look for a response. I hope that it would come to my email account listed.
Thanks again.

Lara Pizzorno

Hi Shaine,

I’m 63 – and my bones have now fully recovered from severe osteopenia that was found when I was in my late 40s. I promise you, you can completely restore the full health of your bones – safely, naturally and inexpensively! You just need to provide your bones with the nutrients they require to rebuild, stop doing any of the things I discuss in Your Bones that you might be doing that promote inflammation, and get a little weight bearing exercise. And following these recommendations is not only going to give you strong bones, but vibrant health overall. Definitely a win on all fronts!

Re strontium – yes, the ratio you want is approximately twice as much calcium as strontium. Remember, however, that you are most likely getting calcium from your diet, too – this counts! In Your Bones, I provide a listing of the common foods richest in calcium, so you can take a look and estimate about how much calcium your diet is providing you. For most of us, it’s at least 400 mg /day. Even if you are not eating dairy foods (cheese, yogurt, cottage cheese, milk), plenty of other foods are great sources of calcium – e.g., tofu, soymilk, salmon, sardines, spinach, sesame seeds, almonds, broccoli – etc. You may be surprised to see how much calcium your diet is providing when you add it up.

For my MK-7 needs, I use AlgaeCal’s AlgaeCal Plus – it provides me with not only K2 (as MK-7) at a dose of 100 mcg –an amount shown in the research to be effective – but a highly bioavailable and effective form of calcium, also magnesium, boron, and a whole mix of trace minerals – all of which play a role in bone health. AlgaeCal Plus also contains vit D3, but the dose is 1,600 IU, not enough for me because I have genetic issues that require I take 10,000 IU per day of D3 to get my blood levels into healthy range. You will need to get your blood levels of 25(OH)D [this is the circulating form of vit D and the best indicator of body levels] checked to see where you are, optimal range is 60-80 ng/mL. If you find you are below this range, increase the amount of D3 you are taking and retest in 3 months. We have found in the more than 6,000 patients we have now tested in a health promotion project we have been involved in up in Calgary that virtually everyone needs at least 2,000 IU per day, many need 5,000 IU per day or even more.)
Here’s a link to AlgaeCal’s product:
I also use their strontium boost product – it’s less expensive for me since I order 6 months of both at a time and get a good discount on the price, and also don’t have to think about having to order something more than twice a year.

If you have your vit D3, calcium, magnesium, boron, etc., needs already covered, and all you are looking for is a vit K2 supplement, then I would suggest Life Extension’s product, Super K with Advanced K2 Complex – it contains K1, MK-4 (very small amount though) and MK-7 (effective dose). All 3 forms of vitamin K are beneficial – K1, which you can get in abundance from green leafy vegetables, is highly anti-inflammatory as well as being required for normal blood clotting, so you don’t bleed to death from even a tiny cut. I just eat lots of greens – they are a great source of so many minerals and phytonutrients that are good for us as well as K1! MK-4, even at such a low dose, can’t hurt and may help. You can get this small amount of MK-4 from foods though – a list of food sources is in my vit K2 review on LMR. Cheese is one of the best food sources of MK-4; Jarlsberg and Emmenthaler cheeses are the richest in K2. I love both, and try to have an ounce regularly – great for a snack with an apple, in omelets, and my family’s all time favorite – wonderful in tuna melts (I make tuna fish salad with canned tuna, omega-3 rich mayonnaise, lemon juice and a tablespoon of capers or jalapenos, spread it on whole wheat bread, top with a slice of Jarlsberg, spray the top of the sandwich with an organic olive oil version of PAM, put it on a cookie sheet and toast it the oven at 350 degrees for about 20 minutes. One caveat here –if you eat tuna PLEASE purchase tuna that has been checked for mercury content! I get ours on-line from Oregon’s Choice – it tastes so much better than StarKist, absolutely no comparison, and while the cost per can is higher, the cans are several ounces bigger.
Here’s a link to the LEF product:

Hope this helps you,


Are there any concerns with taking Synthroid medication and taking AlgaeCal Grow Bone System? I take Synthroid medication 75mcg. a day first thing in the morning on an empty stomach. At what time in the day would it be best to start the AlgaeCal Grow Bone System after taking my Synthroid?
Thank You.

Lara Pizzorno

Hi Joanne,
You absolutely can take AlgaeCal Plus and Strontium Boost while taking Synthroid — which is levothyroxine (T4). After testing several years ago revealed that my throid function had dropped a bit as I’ve aged, I was prescribed levothyroxine myself –a smaller dose than you, just 25 mcg daily. And I have now been taking AlgaeCal Plus and Strontium Boost for almost a year with no problems.
You just want to avoid taking anything (food or supplements) that contains calcium or iron within 4 hours or any soy products within 3 hours of taking Synthroid since these can reduce absorption of the drug. Even if you slipped up and had calcium or soy earlier, it would not completely prevent you from absorbing the Synthroid. It just might lessen its absorption. And also realize that they are giving you the maximum time span between taking the drug and consuming calcium, etc., to ensure that everybody — even those of us whose absorption is the least efficient — will have absorbed the drug.
You could take AlgaeCal Plus with lunch and dinner, then take the Strontium Boost before going to bed. You also want to take strontium several hours after consuming anything (food or supps) with calcium in it. The reason is similar — the two minerals compete for absorption, and calcium is going to win, so you won’t get as much benefit from the strontium.


Thank you for the information and answering my question completely. I will follow that regime. It seems like there is Iron in almost all foods so it is hard to avoid foods without Iron. I didn’t realize that until I started looking at the labels on food packaging, etc. One other question. I have read that one should avoid taking magnesium as well with Synthroid within the same time frame. Do you know anything about that? I see that there is Magnesium in the Raw Calcium. I know we need that and I am guessing that if I wait 4 hours it should be OK.
Thank you.

Lara Pizzorno

Hi Joanne,
I believe the issue is primarily with supplements, not foods (except soy foods), the reason being that supplements contain concentrated amounts of the nutrients they supply. In a typical serving of most foods, the amounts provided are not going to be a problem. Although red meat concentrates iron. And dairy products can deliver a hefty dose of calcium. In the case of soy foods, they are considered goitrogens — although the latest research indicates this issue is overstated — here’s a link to an excellent discussion of current research-based thinking about goitrogens on World’s Healthiest Foods,
Bottom line here — You want to avoid taking calcium and iron supplements for 4 hours, and to err on the side of caution, avoid soy products within 3 hours of taking levothyroxine. Grapefruit juice may delay the absorption of levothyroxine, but it is not believed to have a significant effect on bioavailability. Other substances that reduce absorption are OTC and prescription drugs — e.g., aluminium and magnesium containing antacids, simethicone or sucralfate, cholestyramine, colestipol, Kayexalate. Some other drugs cause potentially severe adverse effects — these include Ketamine (which is primarily used in humans to help induce and maintain general anesthesia, so if you are having surgery, you will want to mention that you take levothyroxine) — ketamine may cause hypertension and tachycardia) and tricyclic and tetracyclic antidepressants increase its toxicity. Lithium affects iodine metabolism in the thyroid gland and can therefore also inhibit metabolism of synthetic levothyroxine as well.
Easiest is to just take your levothyroxine right when you awake in the morning — and take your supplements a few hours later — e.g., with lunch, dinner and before bed. The foods most of us have for breakfast — juice, coffee or tea (cream is basically fat so little calcium), cereals (e.g., hot oatmeal or the various flaked cereals — you can have rice, almond or coconut milk with these ), eggs, whole grain toast with butter and jam — none are going to be problematic.
Of course, as with everything else, you need to see how YOU are reacting, how YOU are feeling. If you think you are not absorbing your levothyroxine well, your doctor can run a test to check your thyroid hormone levels.


Hi Lara,
so interested to read you and your incredible store of information especially about Strontium Citrate. Since being diagnosed with osteoporosis [-3.5 spine, -2.7 L. femoral neck] and Osteopenia [2.1 L. hip, 2.2 Rt hip. -2.4 rt. femoral neck] last July, I have been following the Save our Bones programme, taking Raw Calcium, a special over 50 muli- vitamin and other supplements. I do Yoga and Pilates x1 a week, joined a walking group on Sundays, try to use weights when can. Watch acid/alkali balance. Drastically reduced milk as they say it becomes acidic in the body switching to rice milk, hemp and now almond. have soya yogurts [ I’ve suffered from 1/2 hourly hot flushes for 5 years]. I am a fish vegetarian so eat healthily catch the sun and walk whenever I can. I have lived with a lot of stress at home and at work but try to meditate when poss. I just had another Dexa Scan as I’ve had 2 fractures on each ankle in last 4-5 years and am terribly disappointed to find a slight fall in score. I thought I was doing everything right. I have been scared to take Strontium but am now wondering if should, I would be so grateful for your advice and suggestions,
many thanks, Sara

Could you please comment about this article re: strontium ranelate. For those of us taking strontium citrate I personally find this article to be somewhat disturbing. Granted it refers to individuals with preexisting conditions, but still….
Thanks for all the time that you take to answer our many questions.
There was also a question on the inspire site regarding taking 1/2 the recommended dosage and finding better results. I look forward to your response on this as well.

Lara Pizzorno

Yes, as you will have noted in my blog on strontium, the patented/drug version of strontium, strontium ranelate has now been conclusively shown to produce numerous side effects, at least two of which, VTE and DRESS syndrome can be fatal. In contrast, as I stated in the above blog (and backed up with studies conducted over the last 100 years–the citations for which are provided in the references) , the natural form of strontium available as a supplement, strontium citrate, has never been shown to produce any of the side effects seen with strontium ranelate. The only issues with strontium citrate (or any form of strontium) are that to err on the side of safety, you should be consuming twice as much calcium (from both diet and supplements) as strontium AND you should take your strontium supplement several hours before or after consuming calcium. This is because the two minerals compete for absorption, and calcium will win out, so you will get less benefit from strontium consumed at the same time.
Regarding taking 1/2 the recommended dosage — I have not seen anything in the research to indicate this would be better. However, as I hope I keep repeating, each of us is UNIQUE. You must observe your body’s reactions to anything you do — and respect them. I project that in another 20 years (maybe even sooner), we will be able to have genetic tests run that will clearly indicate for each of us our specific needs and susceptibilities. We already can get this information for some things — for example, my genetic inheritance includes a SNP that makes my vitamin D receptors less able to latch on to vitamin D, so I need much more vitamin D than the “average” person to get my levels into a healthy range. Eventually, I expect we will be able to get our full “genetic template”. We don’t have it yet though. So we must experiment. We can learn from what works for others, but this does not necessarily mean it will be effective for each of us. What we can do is see how our body appears to be reacting — in other words, how do you feel? And we can check, in terms of our bones, what’s happening with NTx and DXA tests, also our vitamin D levels, and I’m hoping soon the test for vitamin K levels (it’s called unOC, which stands for uncarboxylated osteocalin) will be widely available. I wish it were less complicated, and we could all just do exactly the same thing, and it would be just right for each of us — but this is not how it is. We can help guide each other towards what is highly likely to be beneficial — we cannot be each other. And truly, isn’t this wonderful? We are, each of us, special, unique and irreplacable.

Lara Pizzorno

Hi Sara,
I’m sorry, but I do not know the details about the Save our Bones program, so I won’t comment on that. Also, I don’t know what “raw calcium” is. What I can offer you are some suggestions in response to what I see in your note to me — this will sound like an advertisement, but I urge you to get a copy of Your Bones and read it! Your library should have it if you don’t wish to buy it. Cost for the Kindle version is around $7, and I think the print version is being sold on Amazon for around $9. In this book, I go over all the many factors that can contribute to bone loss that you may not be aware of, every nutrient your bones need to build, how to determine if you are getting enough from your diet and how to choose a supplement if you need more. I also discuss bone building exercises and diet. It’s way too much to try to share with you in a response here — and I don’t know what, in particular, will be most important for YOU, only you can determine this by reading the material yourself and thinking about it in relation to YOU.
That being said, your note suggests to me that if you have not already had your vitamin D levels checked, you should do so! The test you want run is for 25(OH)D– this is the circulating form of vit D and the best indicator of body stores. Optimal levels are now considered to be 60-80 ng/mL.
If you are not consuming any dairy products, your diet is most likely providing very little if any vitamin K2, for which the best source in the western diet is cheese, particularly Jarlsberg and Emmenthaler. (And I disagree that dairy is necessarily bad. The issues are (1) allergies to the proteins in dairy (2)non-organic dairy — don’t have this!many reasons too many to go into here (3) a diet excessively high in protein will produce an acidic body chemistry. Since your diet is vegetarian/pescatarian, this should not be an issue for you. In Your Bones, I explain how to determine if your diet is too high in protein for YOU.
At any rate, you will certainly need to supplement with K2. I discuss the research on K2 and the 2 forms available as supplements in Your Bones. I recommend (and use myself) the MK-7 form of K2 for a number of reasons — too many to go into in any meaningful way here. If you would like to learn more about K2, I’ve written a review for physicians of the latest research on this nutrient; you’ll understand the key points despite the medical jargon — it’s available via this link:
My third suggestion for you is to have your doctor order a 24 Hour Urine test to check all your hormone levels — best lab for this is Meridian Valley Labs. Here’s a link:
You do not have to be suffering from 1/2 hourly hot flushes! Once you are tested and find out where your imbalances are (and this will be clearly shown on the 24 Hour Urine test for all the estrogens, progesterone, DHEA, testosterone, your adrenal hormones — and more), you can restore balance. Bio-identical hormone replacement –formulated specifically for YOUR needs by a compounding pharmacist–will take care of this in a month or less (and protect your bones, your heart and your brain). I’ve written quite a bit about BHRT (which I am on and have been on for more than 10 years now) — you can read many these articles on Smart Publications website — here’s a link to a page with a number of them:
If you would like to read up about hormone testing — and the 24 Hour Urine, I wrote an article for physicians about all this that is available at Longevity Medicine Review — here’s a link:
Lastly, regarding strontium citrate — it has been shown in MANY studies, thousands of women, to be safe and effective. You just need to take it at a different time of day from when you take calcium (as I have written in the blog and in response to questions here, calcium and strontium compete for absorption, and calcium is better absorbed, so if you take them at the same time, you will receive less benefit from the strontium.) Also, you want to consume approximately twice as much calcium (from food and supplements) as strontium. I use AlgaeCal Plus for my supplemental calcium and vitamin K, and part of my vitamin D (I need additional vitamin D because of my genetic inheritance– my vitamin D receptors don’t work very well, so I need more vit D than most people), and I take Strontium Boost for my strontium. It works best for me to take AlgaeCal Plus in the morning and evening and Strontium Boost with lunch. If I end up having dairy foods (like cottage cheese or yogurt or cheese) at lunch, I just take the strontium around 4 pm with a dairy free snack.
Most importantly, I want to encourage you NOT to put up with bone loss and twice hourly hot flushes — both are completely fixable! Obviously, what you are currently doing is not meeting YOUR needs. This is what your body is telling you! It’s going to take some work — I very much hope you will read the articles and Your Bones for solid, research-backed information and get the appropriate tests run (I also discuss a number of tests in the book–when you read the sections in which they are mentioned, you will know if they are ones you should consider), but you absolutely can figure out what YOU need. When you have more questions — which I expect you will as you travel down this road of self-discovery (a challenge, I know, but also you will soon discover that YOU can take control of your health!) — just let me know. I will do my best to help you.

Barb Blonsky

Hi Lara. I take a 1000 mcg. strontium supplement. What is an adequate amount is for post-menopausal women to take? I have severe osteoporosis at age 56. I’m thin and have trouble gaining weight. I don’t eat dairy or Night Shade vegetables (I’m on an anti-inflammatory diet which has helped both the beginnings of arthritis and COPD diagnoses about 4-5 years ago). I do eat nut butters, avocados, and meat to get my fats.


Lara Pizzorno

Hi Barb,
In the research on postmenopausal women, the amount of strontium shown to be effective in helping to increase BMD is 680 milligrams per day. Is your inflammation under control now that you have eliminated dairy and nightshade vegetables from your diet? If not, is there anything else that might be contributing to it that you could change to lessen inflammation? Are you getting sufficient omega-3 fatty acids? Are you able to eat omega-3 rich fish like wild caught salmon or would you consider taking a DHA/EPA supplement? Are you aware of the research on glutathione (given via nebulizer) for COPD — it is VERY helpful!

Barb Blonsky

Hi Lara. The strontium I take is 1000 mcg. Yes, my inflammation is under control. I’m also taking an EPA supplement that has 1536 mg. I’m also thankful I can and I love salmon! My COPD isn’t an issue any longer, since Dec. ’09. I have a lot less coughing for no apparent reason. I quit all meds. for it at that time.


Lara Pizzorno

Hi Barb — wow, that’s wonderful!
Just be sure to have wild caught rather than farm-raised salmon. For lots of information on salmon — here are a couple of links to World’s Healthiest Foods discussions of salmon:
(I helped create the content on WHF and continue to help maintain it)
Re strontium — the amount you are currently taking is very low! 1,000 micrograms is far below the 680 milligrams (which is the equivalnt of 680,000 micrograms!) shown in the research to be helpful. You might consider taking a strontium citrate supplement providing approximately 680 milligrams of elemental strontium–this is what Strontium Boost delivers, and there are other strontium citrate supplements available that also provide this dosage.


I am in my 50’s and in menopause. I thought I was suppose to get 1200mg calcium. With the algaecal are you assuming I will eat another 500mg? If I don’t should I take more algaecal? Is taking the algaecal would be just like eating calcium rich food such as kale, and not considering a supplement, such as taking calcium citrate. Does that mean it won’t clog my arteries like I have been reading about with calcium supplements?


Hi Sandy,

Thanks for taking the time to post a comment on our blog. Research shows that the average American gets about 600 mg of calcium from their diet, so if you are aiming for 1200 mg of calcium per day the average person would need to supplement 600 mg of calcium.

Your best bet is to find out how much calcium you are getting from your diet and then supplement as needed. A good tool to monitor your diet is the AlgaeCal Bone Health Calculator. You can enter the foods you have eaten and the calculator will tell you how much calcium, magnesium, vitamin K and vitamin D you are getting from your diet. To try this tool please visit

There is an online version, a software that you can install on your computer and also an iPhone app. Please note we are currently working on the calculator to include more foods, but for now it will give you a good idea of your intake levels.

And yes AlgaeCal is considered a whole food source of calcium so research has shown that food sources of calcium are safe and have not caused clogging of arteries as seen in recent studies involving rock based calcium like calcium citrate etc… Also research shows that AlgaeCal calcium is effective at lower levels of calcium, you can read all about the comparison between AlageCal and Rock based calcium on this page

How Much Calcium do you Get from AlgaeCal?

AlgaeCal Plus contains 180 mg of calcium per capsule

AlgaeCal Plant Calcium +D3 contains 250 mg of calcium per capsule.

I hope this helps answer your question, thanks again for commenting

Audrey Yzaguirre

I have been taking Pure Encapsulations Strontium as per doctor’s suggestion, but have run out of it. I am out of the country and want to order some Strontium, but can’t figure out which is the best one to take.

Thanks for your help.

Lara Pizzorno

Hi Audrey,
Any supplement providing 680 mg of elemental strontium in the form of strontium citrate will be fine. My only consideration would be the quality control level of the company selling the product. You want to be sure what you are getting is not adulterated or contaminated. Pure Encapsulations and AlgaeCal are two brands you can trust, and so are a number of other brands. If you can send me the names of the companies from which you are able to purchase stronium where you are, I will look at their quality control standards and let you know which I would feel comfortable trusting.


Just curious- did you get your DXA in April? Did the results convince you that this regimen is beneficial? Or, not?

Lara Pizzorno

Hi AJ,
I just had my DXA run May 1st. My results have TOTALLY convinced me. I had been building bone for several years; improvement was consistent but slow. Last summer (July 2011), I switched to AlgaeCal Plus as my source of supplemental calcium and to Strontium Boost for my strontium supplement. This is the only change I made to what I had been doing. BMD in my spine is up 6%; BMD in my hip/femur is up 3.2%. I am barely osteopenic now; my T-score went from -1.9 to -1.5. Since I made no other changes, I believe AlgaeCal is a major contributing factor to these improvements.


Hi Lara:
I have a dilemma. I have been taking strontium citrate for two years. am presently in my third year taking it. My last dexa scan (summer of 2011) indicated that there had not been any decline in my bone density. (This was a very positive result since I had bone loss for other prior dexa scans.) My dilemma,however, is that I have been losing height. In the past two years I have been measured to be one inch shorter. I cannot understand this. What is your input regarding this?

Lara Pizzorno

Hi sml,
I suggest you ask your doctor about getting a “Vertebral Deformity Assessment” — this is done on DEXA machines using special software that takes a side (lateral) view of the spine and provides an image of each vertebra to see if there are any deformities or fractures. They would also look for vertebral “wedging,” which may occur since, when the spine loses bone density, the vertebrae may compress down wedging over the ones below them. This would explain your loss of height. I don’t know what type of exercise regimen you follow, but in both exercises and your daily activities, it is very important NOT to do movements that flex your spine forward into a big “C” curve. You want to do exercises that strengthen the muscles running up your back along both sides of your spine — these are called the “multifidi” and “erector spinae”. Pilates exercises with an instructor who has been trained to work specifically with people with bone loss may be very helpful for you. These exercises can help you strengthen the muscles that support your spine, so can help you to decompress and re-elongate your spine. The great people at AlgaeCal were kind enough to tape a number of video clips in which I demonstrate some of these exercises, and I also provided some copy describing them and briefly explaining why Pilates is so helpful for those of us with osteoporosis. I believe these will be posted on AlgaeCal’s website soon.
Hope this helps, Lara

Lara Pizzorno

Hi Sandy,

THANKS for catching my misspelling of Dr. Genuis — although “Genius” would be more appropriate for his insights and accomplishments with the COMB research, and more fun (have you ever noticed the synchronicity between peoples’ names and their professions or accomplishments? Our dentist is Dr. Carie, and the lead author of a recent paper on men’s fish consumption, omega-3 levels and sperm count and activity is named Attaman. Such occurences add smiles to our days 🙂 )
OK — to your questions:
Re their recommendation of impact exercise for the participants in this study, I believe it was reasonable and helpful — here are the reasons why.
(1) Key point in the COMB paper is the “where possible” in this quote from the paper:”Patients were also instructed to commence and maintain a regimen of daily impact exercises such as jumping jacks or skipping where possible as impact has been associated with prevention of bone density loss.”
The bone density distribution in COMB study subjects ranged from normal, although low, BMD in comparison to age-matched controls since these were premenopausal individuals (25%), through (among the postmenopausal women), from slightly reduced (5%), to osteopenia (42%), to osteoporosis (29%). Thus, for 71% of the participants in this study, a short daily period of exercise, a few minutes of which was high impact exercise, was a reasonable and safe recommendation. Subjects with osteoporosis were not told to go home and do 300 jumping jacks.

(2) The first study cited by Genuis et al. as the basis for the exercise recommendations used brief (10-15 minute) periods of exercise, and these included several minutes for warming up and several for cooling down, so time spent at the ‘high impact” level was around 5 minutes per session. As you can see from the references listed below, in the Niu et al. study, the exercises were conducted during short breaks from work at the office.
The other study cited (Korpelainen et al.) used a more aggressive exercise program. Subjects were 160 postmenopausal women, mean age 73 years, with a hip BMD value of more than 2 standard deviations below the reference value, so clearly well into the osteopenic / osteoporotic range. The women in the exercise group were asked to attend hour-long training sessions, supervised by a qualified physiotherapist, for a 6-month period each year (this was a 30-month study) and were also asked to train 20 min daily at home following a program of similar exercises to those in the supervised sessions. For the remaining 6 months, the women just exercised at home. Both the supervised and home exercise programs were updated every 2 weeks to ensure progression and versatility.
The supervised exercise sessions were undertaken as group activities. Approximately 45 min of each session was devoted to jumping and balance exercises, including walking, knee bends, leg lifts, heel rises and drops, dancing, stamping, stair climbing and stepping up and down from benches. Each session included a 15-min warm-up period.
Problems were minor and did not prevent any of the women from continuing to exercise – although for a few of these women, their program were modified to meet the individual’s needs. Three women in the exercise group experienced musculoskeletal problems that required minor modifications in their training regimen. All of these women completed the exercise program without further problems. Two women had to suspend training for a few weeks due to knee arthroplasty, six women due to neurological or cardiovascular problems and six women due to glaucoma surgery. None because of adverse effects on bone. They ALL returned to the exercise program and completed a modified regimen without problems.
So, 30 months of weightbearing (and high impact) exercise in these older women with a BMD at least 2 SD below the reference value proved to be safe and showed efficacy in slowing or stopping bone loss, especially at the trochanter, and the exercisers also had less fall-related fractures than the control group during the follow-up period.

My understanding is that a key reason high impact exercise is beneficial is that it engenders the production of signals that tell bone to build, and these signaling mechanisms do not require long bouts of exercise for activation. A little daily high impact exercise by women in the mildly osteopenic range should be safe and may go a long way towards maintaining healthier bones.

Here are the citations for the studies upon which the COMB researchers based the study’s exercise recommendations:
K. Niu, R. Ahola, H. Guo et al., “Effect of office-based brief high-impact exercise on bone mineral density in healthy premenopausal women: the Sendai Bone Health Concept Study,” Journal of Bone and Mineral Metabolism, vol. 28, no. 5, pp.568–577, 2010.
R. Korpelainen, S. Keinänen-Kiukaanniemi, J. Heikkinen, et al. “Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention,” Osteoporosis International, vol. 17, no. 1, pp. 109–118,2006.

Other studies — a number of which are cited in the above 2 papers — have also shown that weight-bearing and high impact exercise prevents bone loss and helps prevent fractures, both by maintaining and/or improving BMD and by improving balance, thus preventing falls.
The most current research looking into the use of “high velocity progressive resistance training” is just underway and will, hopefully, give us more insight into the best exercise protocols to prevent bone loss and rebuild osteopenic, osteoporotic bone. I’ll be following this research and will report the results. (Here’s the citation for this study: Gianoudis J, Bailey CA, Sanders KM, et al. ‘Osteo-cise: Strong Bones for Life’: Protocol for a Community-based Randomised Controlled Trial of a Multi-modal Exercise and Osteoporosis Education Program for Older Adults at Risk of Falls and Fractures.BMC Musculoskelet Disord. 2012 May 28;13(1):78. [Epub ahead of print]PMID: 22640372)

My personal thoughts overall:
Clearly, anyone with severe osteoporosis should work with a well qualified physiotherapist, and my preference would be the use of a highly supportive and very safe exercise regimen like Pilates — which has also been shown to be able to target and help build specific areas of bone — until bone density was restored to the osteopenic level. Then I’d recommend something like Zumba because it can not only be high impact (you can always modify the steps to be low impact), but is so much fun that compliance is a delight. We’re not wanting to have healthy bones just to stay above ground on the planet; as the song lyric says, “Girls just want to have fun!”

In regards to your question about strontium being taken as a single dose in the COMB study, this is not unusual. Remember, the women were not taking calcium supplements, just getting their calcium via the foods in their normal diet, so not restricting the time during the day when they took their strontium citrate also seems reasonable. It is true that calcium and strontium compete for absorption –and calcium will win out in this competition, so maximum benefit from stontium will occur when large doses of calcium are not being ingested at the same time. However, unless these women were consistently taking their 680 mg strontium supplements with meals providing comparably large doses of calcium — an unlikely situation — they would receive some benefit from the strontium. Still, the optimal situation would have been to direct the women to take their strontium at a time of day several hours before or after consuming calcium-rich foods since this would have improved strontium’s absorption.

Thanks again for catching my misspelling of Dr. Genuis name and for your really great questions, Lara


Hi Lara,
I have osteoporosis–2.9 in spine -2.6 in hips. Can you please tell me what you are taking every day and when you are taking them? I guess I’m asking for a protocol to follow for someone that doesn’t have Vit D absorption issues. I would love to have a list of supplements to take every day and when I should take them. There is so much info out there and I am so confused on what to buy and when to take them. Besides the Algaecal and Strontium Boost, what are you taking daily?
My Dr. wants me to go on Fosamax and I have said no. I am trying desperately to improve my DEXA so I can prove him wrong. Congrats on your Dexa scores by the way-how wonderful!!
I’m very thin by nature 5’3″ and barely 100 lbs with a strong family history of osteoporosis so I need help!
Thank you for your time. Betty

Lara Pizzorno

Hi Betty, I’m on the road — literally, on a motorcycle trip with my husband. We’re en route back to Seattle from meetings in San Luis Obispo. So please forgive me for not responding sooner — this is the first place in several nights where we have had internet access. My best suggestion for you is to get a copy of Your Bones — your library will surely have it if you do not want to purchase the book, but it costs less than $10.00 on Amazon. The book will help you understand what YOU need and figure out how much you need to take as a supplement in addition to what you are getting from your diet. To figure out what YOU need, you have to look at the contributing factors to bone loss, see which ones are a potential problem for YOU (and the book will help you figure this out), then you need to look at YOUR diet and see what nutrients your bones need that you are already getting and whether you need to supplement — and if so, you will be able to figure out how much YOU need in a supplement of the various nutrients. I really get it that we all would rather just be told, “Take this pill,” but the problem is that we are all different, we are all unique, so your needs may not be met by taking what I need (and I do have vitamin D issues, so I need lots more of this nutrient than the average person, which then means I need more of other nutrients like vitamin K2 and magnesium and vitamin A as well — so I cannot just tell you to take what I take. While reading Your Bones and using it to figure out what YOU need sounds like a huge hassle, I promise, it won’t take you that much time — and aren’t you worth a few hours of reading and then looking at your diet to see what YOU need? On average, (and as I hope you know, the mythical “average” person does not exist) if you do not have vitamin D absorption issues, you will most likely need somewhere between 2,000 and 5,000 IU per day of D3 (you have to have your bloood tested to see what your D levels are and then work from there– this is explained in the book); 100 micrograms per day of K2 as MK-7, and 1,200 mg of calcium (but remember, this includes the calcium you are getting from your diet, so you will need less in supplemental form). You also need boron (3 mg), magnesium (about 2/3 as much magnesium as calcium). These are key nutrients but there are others — you should be taking a good multiple vitamin / mineral supplement as well. I take AlgaeCal Plus along with my multiple vitamin and I need extra vitamin D and K2 and magnesium in the morning and at night. I take extra vitamin A several times a week in the morning. I take Strontium Boost with lunch. The key issue is to take strontium at a different time of day from when you take calcium or eat foods rich in calcium because calcium and strontium compete for absorption, and calcium wins, so you will get less benefit from the strontium you take if you take it at the same time as a larger amount of calcium. Botttom line here — it will take you several hours to read Your Bones and then you will need to keep a food diary for a few days to see what your diet is providing. You will then be able to know what YOU need and set up an effective plan for YOU. After that’s done — it’s so easy. Just avoid the things you will have identified that are contributing to your bone loss (these are all laid out in the book), eat well, get regular weight bearing exercise, and take the supplements you now know YOU need. If you have further questions as you are working out your plan, please write me. I will do all I can to help you.
One last thought — if you have a strong family history of osteoporosis and vitamin D is not a key contributing factor, then I urge you to have an osteoporosis genetic panel run to see what else might be going on in your family. These tests are not all that expensive now and can be a huge help in identifying what your key issues are — the best lab I know of that is providing this type of testing is Genova Diagnostics (I have NO financial links to this company! I do know the people involved and they are outstanding; top quality, high integrity; and this is the lab through whose genetic testing I initially discovered my vitamin D issues more than 15 years ago now. Genova was one of the first to develop these tests and has long been the leader in genetic testing. Here is a link to them:
I know this is not what you wanted, but I very much hope it will help you, Lara


Hi Lara,
I had a small fracture in the pelvic area. I was taking Fasomac for three years with the doctor’s advice. I heard it was not good to take it so long. I came off and just took calcium supplements. I am now taking Algaecal for about a month. I had a bone density test done and found out I have low bone density which I know is not good. I can only have a bone density test done every two to three years. Can you give me some advice as to the best course I can take to prevent another fracture. I appreciate your knowledge and insight into women”s bone health. Also can you tell me where I can buy your book…Thank you so very much. I live alone and lost my family. So I need all the help I can get now…… God Bless you …….Audra

Lara Pizzorno

Hi Audrey,
I hope you will pick up a copy of Your Bones from Amazon — I just checked there and see it is now available for just $6.98 new or $5.64 used. Here is a link to it:
If you prefer not to buy a copy, your library should have it.
Please do read it! I cannot rewrite the entire book here — and there are many things that contribute to excessive bone loss which I discuss in it besides the followig. Since one of these other issues might be the most important one for you, truly it is best to get hold of a copy and read through them all. For right now, a few key things that come to mind are the following:
What are your current vitamin D levels? If you do not already know, you can find out by having a simple blood draw for a lab test of your blood levels of 25(OH)D — the most sensitive indicator of your body levels of vitamin D. Optimal levels are 60-80 ng/mL. If your levels are very low, you may need more vitamin D3 than is supplied by AlgaeCal Plus. If your levels are already at least above 30 ng/mL, you could try just taking AlgaeCal Plus (which provides 1,600 IU of D3 daily) and then retesting in a couple of months to see if they improve. If your levels are quite low, you may need as much as 5,000 IU of D3 daily–or even more than this — to get back into a healthy range. Please discuss this with your doctor.
AlgaeCal Plus is supplying you with the dosage shown to be effective in the research (100 mcg) of another absolutely essential nutrient for bone rebuilding — vitamin K2 (as MK-7), which you are highly unlikely to get from your diet, so you need a supplement for this– AlgaeCal provides it, so we don’t need to be concerned about that. Also calcium, magnesium, boron and some vitamin C are already being provided for you by AlgaeCal Plus. If you are also taking Strontium Boost (and be sure to take it at a time of day when you are not consuming calcium as strontium and calcium compete for absorption, and calcium wins out, so you will not get as much benefit from your strontium. Take your strontium several hours before or after having calcium — in foods as well as supplemental calcium. I take my AlgaeCal Plus first thing in the morning and right before going to bed. I take Strontium Boost with my lunch (and try to remember to not have calcium-rich foods at lunch. If I am out and must have foods high in calcium at lunch, I take it late in the afternoon, so several hours after lunch.)
It is also VERY important that you are eating a healthful, whole foods, anti-inflammatory diet with plenty of leafy greens and other vegetables, adequate but not too much protein, and good amounts of omega-3 fatty acids. And weight bearing exercise is essential to get bones to rebuild as well. Even a daily (brisk and energetic) half hour walk will help. I go into all this in detail explaining why, what and how in the book.
Be patient with yourself — Fosamax (and all the bisphosphonate drugs as well as the newer drugs, Prolia and Xgeva) work by preventing normal bone remodeling. These drugs prevent osteoclasts from removing old, worn out bone, so it accumulates — and this is why they eventually cause fractures. You cannot lay down new healthy bone until the old, brittle bone has been removed. It may take 6 months or even a bit longer for your body to begin to restore normal bone remodeling. But if you just supply your bones with what they need to rebuild (and minimize your exposure to the things that promote excessive bone loss–discussed in the book), your bones WILL rebuild and become healthy.
I’m so glad you found AlgaeCal! I know their supplements will be a big help to you. I started taking AlgaeCal Plus and Strontium Boost just last summer–July 2011. I was due to have my DXA test run this May (2012) and am so delighted with my results — I improved significantly in all areas:
•My whole body BMD went from T score of -0.4 in 2011 to a T score of -0.2 in 2012
•My hip/femur went from T score of -1.7 in 2011 to -1.5 in 2012 (a 3.2% improvement in BMD in my hip/femur)
•My spine went from T score of -1.9 in 2011 to -1.5 in 2012 (a 6% improvement in BMD in my spine)
I had been rebuilding bone for several years, improving consistently, but much more slowly than this. Now, while I am still just slightly osteopenic, I am clearly, very rapidly rebuilding bone. Since the only thing that changed in my personal bone-building program from 2011 through 2012 was switching to AlgaeCal Plus as my calcium supplement (I had already been taking another strontium citrate product for more than a year), I believe that the sea-algae derived calcium used by AlgaeCal has been a significant contributing factor to my really great improvement. Since osteoporosis runs in my family, and I have LOTS of genetically inherited issues that cause me to be at much higher risk for osteoporosis than “normal” people, if AlgaeCal’s program helped me, I know it can do the same for you.
I hope this helps. Please just let me know if you have any other questions, Lara


I was just diagnosed with osteoporosis at age 55 and am totally in shock. I have exercised diligently every chance I got and still do with weight bearing exercises and I mean lifting a lot of weights , never smoked or drank, maintained a healthy weight , ate the fortified whole grain cereal and breads and have it in my spine. I did all these exercises and lived a healthy lifestyle to prevent osteoperosis because my grandmother had it. She went through sudden menopause at age 40 – which I understand contributes greatly to the disease , however, I did not and now have it. My d level was checked by my request along with other levels and the only one that was aweful was D. My dexscan was taken with metal from zippers, jewelry, underwrites etc., so I requested it be done over and was told that the presence of metal would make my dexscan numbers better. I don’t understand this – I thought that the absorption and scattering of the rays would make the absorption by the bone worse and give it a bad result. Either way I think in order to know what my real bone health is I should have another one done. I have been crying a lot and am on supplements citrical + D with genistein plus a multivitamin to bring up my aweful D. My husband reminded me that my grandmother just got shorter and cleaned houses for a living until she was 85. She never drove and relied on public transportation to get to her many jobs and activities with no extra supplements of any kind . Will the D help in any significant way to creating new bone in my spine and improve my overall density? I have now started walking at least 3 miles a day sometimes more, in addition to my regular daily weights and 2 nights of Zumba. Do you know anything about genistein or am I wasting more of my time and money taking this additional ingredient? I looked it up on the CDC website but from it I couldn’t tell what the overall conclusion was because I think it was injected. I always felt so strong , loading cobblestones into wheelbarrows and wheeling it around and then dumping it, mowing the lawns with a non- self propelled mower for 25 years, shoveling the abundant and heavy snow by myself for over 45 years, carrying my kids up and down a 1000 ft driveway in the snow, walking my dog etc. until that dexscan now I feel like a frail thing. My dr said to live and work out like I did three weeks ago before the scan also said that I could have had this bone density at 30 and never knew it. I am very discouraged and distressed that my life will be forever changed because of this D deficiency that I didn’t know about sooner – if only I knew sooner.
I have always had a small frame, tiny wrists etc., but very strong from all the working out and physical activity I have done- what now?


Hi Lara,
Thank you for your wonderful advice. I bought your book and I use it as a reference It has been so informative. I take more vitamin D now. And I am trying to be patient with myself. I read all your information to other women and I try to learn what is best for me too. Thank you so much for your book and the information you supply to women that need all the help the can get. Because doctors do not tell you the truth when it comes to improving your bone density. And you do. Thank you again…Audrey

Lara Pizzorno

Hi Audrey,
You are SO VERY WELCOME! As the first woman in all the generations of my family I know of who will NOT die an early death due to osteoporosis because of what we (my husband, Dr. Joe Pizzorno and I) learned in the process of healing my bones, I feel I have a deep obligation to pass on the life-saving information I was so fortunate to be able to access. I hope you will join with me in sharing what you learn to help others. Together, we can end osteoporosis! No one needs to suffer from this naturally and safely preventable and reversible disease.
And take heart — MANY doctors are very unhappy just doling out prescriptions for drugs that do not deal with the real causes of osteoporosis (and other chronic degenerative diseases). A new paradigm in medicine — called Functional Medicine — is gaining ground and is the beginning of making truly curative, healing medicine the standard of practice. You can learn more about this new movement in medicine, and even find a referral to a physician practicing this truly 21st century medicine, at the Institute for Functional Medicine’s website:
Be gloriously well! Lara

Lara Pizzorno

Hi Sue,
First, let me reassure you that you can absolutely rebuild your bones! Your exercise has already been a big help to you (you could have lost much more bone without it) and will continue to assist you as your rebuild now that you have learned about your needs for more vitamin D. And knowing that low vitamin D is a key issue for you is great — it’s inexpensive and easy to take more vitamin D (be sure to use D3 not D2 since D3 is much better absorbed and utilized than D2). A fair number of us have genetically inherited needs for much more vitamin D than the (mythical) “average” person requires. I am the poster child for this one – every woman in my family going back all the generations I know about died early from osteoporosis-caused fractures (mostly hip fractures). I will be the first one who does not! I was losing massive amounts of bone in my 40s, years before menopause. And I, too, had been doing everything right. Plenty of exercise, which I love, a really good organic whole foods diet, what was considered a good vitamin program back then — and I had osteopenia that was moving right along to osteoporosis. Being in the medical biz, we have friends on the “cutting edge” of the research and lab testing, so almost 20 years ago now, I had one of the just developed genetic panels run, and we learned that my vitamin D receptors don’t work well, so I need LOTS more vitamin D than “normal” folk do. Such genetic issues are not all that uncommon. It sounds like such genetic issues may run in your family as well — or it may just be a matter of where you live (northern latitude = less exposure to sunlight at the right UVB frequencies for making vitamin D in the skin), your diet (little oily fish, etc.) Once I began supplementing with higher doses of vitamin D, my bones began to stabilize and slowly, to rebuild. Over the last 20 years, I have continued to refine my bone building program as new research has come out on various nutrients involved in bone building, and our understanding of the many factors that can promote excessive bone loss (so we want to avoid them!) has evolved. As a medical writer, I spend my days reading all the breaking research, so I have been in the very fortunate position of being able to amass a huge amount of data with practical relevance for bone health. This is what I summarized in my book, Your Bones. Please consider checking it out from your library or picking up a copy via Amazon. It’s published by a non-profit and is going for less than $5.50 used on Amazon now. And it will give you all the information you need to design a really good bone-building program that meets YOUR individual needs.
Obviously, I cannot recap the whole book here, but I do want to make 2 especially important points — it is extremely important that along with your D3 and calcium, you are getting adequate K2. Vit D increases calcium absorption but does nothing to regulate where the calcium is deposited in your body. You want it in your bones and NOT in your arteries. K2 activates the proteins responsible for making sure the calcium you will now be absorbing because you are taking more D3 goes into your bones. The most effective form of K2 is MK-7; if you are taking AlgaeCal Plus, you will be getting MK-7 in the dose shown in the studies to be effective (100 mcg), along with some D3 (YOU probably will need additional D3), boron, vitamin C and magnesium, along with this highly bioavailable and effective form of calcium. And it’s not just calcium, but calcium in a matrix of all the trace minerals the sea-alage used to build its very bone-like structure. The new research coming out is showing that many trace minerals contribute to bone building. I’ll be writing more about this in the 2nd edition of Your Bones. I began looking into it because AlgaeCal Plus, which I started taking just last July (2011) has made a HUGE difference for me (my spine BMD is up 6%, hip/femur had gone up 3.2% when I had my last DXA run this past May 1st). Until using AlgaeCal Plus, my bones had been rebuilding steadily, but very slowly. Now they are rebuilding so rapidly that I am barely osteopenic.
More good news for you — what you need to do to rebuild your bones is also going to help protect you against cardiovascular disease, cancer, diabetes and Alzheimer’s. It’s totally a win-win-win-win-win situation. Get well informed and take very good care of yourself. Your next DXA will give you one more reason to celebrate your life, Lara


Lara; I just spend a few hours reading your blog. It is most helpful. I was Dx with Osteoporosis (Spine 2.7) and I am taking Fosamax, Vitamin D3, Calcium, mjultivitamin and now Strontium Citrate. I have Celiac disease and therefore have issues with absorbing my foods. I eat a calcuim rich diet and I am staying gluten-free. I am a bit confussed though.My question is am I destroying my bones by taking Fosomax (MD reluctantly gave me bc she said I had no other choice since my numbers are so low) and then trying to rebuild them back with the Calcium and Strontium? I look forward to your reply. Elena


Hi Lara
I have enjoyed reading your blog and found it very informative thank you. I was diagnosed (by DEXA) with severe osteopenia 12 years ago. For one year I tried a lot of high impact and weight bearing exercise, calcium and vitamin D supplements and then had another DEXA. My bone density had not changed. Then I took fosamax for a couple of years. My bone density went up but I developed severe hip pain so I stopped Fosamax. Then I slipped and fell six years ago and got a spiral fracture in my fibula. Since then I have taken Evista (Raloxifene), vitamin D3 and also ‘Calcium Complete’ which is a supplement with a range of bone health minerals plus calcium. For a year I have also been taking Algalcal and Strontium Boost (citrate). I had another DEXA last week and my bone density is now above average for my age (58) and I no longer have osteopenia. I believe my DEXA score is artificially high because of the strontium supplements and therefore my bone density is not as good as the DEXA score indicates. Still I’ll keep on taking Evista (I am in a high risk group for breast cancer and Evista greatly reduces this risk as well as increasing bone density and reducing bone fracture risk), D3, strontium citrate and Calcium Complete. I have been reading about the benefits of vitamin K2 for bone health so this week I went to a Japanese grocery store and bought frozen natto – a tiny 40 gram serve of these fermented soybeans contains 350 micrograms of vitamin K2M7 as well as many other health giving nutrients and only costs one dollar. Much cheaper than buying vitamin K2 supplements. The taste, smell and texture of natto is a little challenging but I can learn to like anything that is so good for me! So I plan to keep eating natto most days as well as lots of green vegetables and get lots of exercise and I hope to have a fracture-free future!

Lara Pizzorno

Hi Mary,
So delighted to hear of your success! If you have been taking AlgaeCal Plus, you are already getting vitamin K2 in its most effective form, MK-7, at a dosage shown to be effective in the research. But it cannot hurt you to take more MK-7 in the form of natto. In studies, women taking even more MK-7 (835 mcg/day) had no side-effects, and their levels of uncarboxylated osteocalcin dropped even lower than those taking 100 or even 400 mcg/day. Also, have you had your blood levels of vitamin D3 checked? You don’t mention how much you are taking. Many people need 5,000 – 7,000 IU per day to get their blood levels of 25(OH)D into optimal range, which is 60-80 ng/mL. If you need more vitamin D3 than you are currently taking, this could explain why you did not more quickly respond to your supplement program. It’s a simple blood test to check — and a good idea to have this test run every 6 months, so you get an idea of how your vitamin D levels change from summer to winter. You may need more vitamin D in winter than you do in the summer months. The SERMS (like Evista — raloxifene) do increase vasomotor symptoms and risk for thromboembolism (so monitor yourself closely), but have been shown to be helpful for the prevention of vertebral fractures, and also to help lessen risk for breast cancer. A healthy whole foods Mediterrean-style diet rich in brassica vegetables (and soy foods–not Mediterranean but very helpful for our bones and vs breast cancer) and low in pro-inflammatory sugars, omega-6 fats, refined grains — processed foods overall — will also greatly lessen your breast cancer risk. Since you are willing to get used to the taste of natto (definitely an acquired taste!), and eating plenty of greens, I am sure you are following a healthy diet. Congratulations on taking charge of your health — you are an inspiration! Stay gloriously well, Lara


Hi Lara,

Thank you for all the research you have done on this subject and for answering our questions. I am wondering if we whould be taking less stontium. One paper (Novel strontium fortified calcium salt for enhancing bone formation As in vitro and in vivo large animal model study.) said something to the effect that 170 mg of strontium per day was more effective than 680 mg per day for reducing fracture risk.

Safety does come first for me, and if at 41 mg/day they saw changes in thyroid I would like to take less. Futhermore if bones follow the pattern of teeth ,then according to the study, “An association between strontium in drinking water supplies and low caries prevalence in man”, maybe I should take 5-10 mg/day . The study found that caries followed a quadratic curve with strontium concentrations on the X-axis; the lowest prevalence of caries was seen with strontium concentrations of approximately 5-6 mg/L.

Lara Pizzorno

Hi Tyler — can you send me the PMID #s for this study, so I can pull the full paper and see what exactly was done and the full results?
Dr. Wright recently commented to me that he thinks it best to start out with 680 mg of strontium citrate daily, but then to drop down to half this dosage or even a bit less once good results have been achieved.
I checked PubMed to see if any further research has come out re strontium citrate — the most recent paper — published just this July in the journal Bone documents excellent results in an osteoporotic woman who began taking strontium citrate at a dose of 680 mg/day in 2008 and has been followed since. Her BMD has continually increased, and after 800 days (the most recent check before the paper was submitted to Bone) strontium retention at her finger and ankle were 7 and 15 times higher than the initial baseline reading. No adverse effects. (Moise H, Adachi JD, Chettle DR, et al. Monitoring bone strontium levels of an osteoporotic subject due to self-administration of strontium citrate with a novel diagnostic tool, in vivo XRF: a case study. Bone. 2012 Jul;51(1):93-7. ) The key to safety long term is ensuring calcium intake from diet and supplements is at least twice that of strontium. And, of course, you also want to be sure to be providing adequate vitamin D to boost calcium absorption from the intestines and adequate vitamin K2 to activate the proteins that then ensure calcium is deposited in bone and not in arteries, kidneys or breasts.


Hi Lara,

Below are the citations of the studies I referenced above.

M.E.J. Curzon, P.C. Spector. “An association between strontium in drinking water supplies and low caries prevalence in man” Arch Oral Biol. 1978; 23(4):317-21. PMID: 278570

Li, Zhaoyang. “Novel strontium fortified calcium salt for enhancing bone formation As in vitro and in vivo large animal model study”. This is a 2007 dissertation paper I found on Europe PubMed Central. You can get it at the following link.

Also I find the lower dosage of calcium in “AlgaeCal Plus” to be more appealing than the plain (360 mg compared to 750 mg); however, I do wonder why does it contain so little calcium relative to the given dosage of strontium; it appears, from the studies and recommendations given on this website, that calcium intake should be greater than that of strontium intake?

Thanks again for your help.

Lara Pizzorno

Hi Todd,
Calcium dosage in AlgaeCal Plus is actually 2x 360 or 720 mg/day as recommended daily dose of this supplement is 2 capsules, twice daily. EASY to miss this — I did for the first several months after I began taking AlgaeCal Plus.
THANK YOU for the links to these papers! So interesting! (I realize you have read these papers, but wanted to include a couple of quotes from them for others who may be interested and have not.)
Curzon study — especially interesting to me was “This effect seems to reach its optimum when concentrations of Sr at 5 to 10 mg/l with 1 mg/l of F are present in the drinking water for man.” As you probably know, fluoride in excess is damaging to teeth and to bone. I recently wrote a blog on this, which is posted in the blog section of AlgaeCal’s website, so I would not recommmend taking fluoride, but given how much of our water in the US is fluoridated, we are surely getting this much (probably more, which may not be good). In terms of this small an amount of strontium having beneficial effects on bone as well as teeth — I have not seen any research indicating this low a dose would be beneficial in bone.
Could you let me know what research you have seen suggesting effects on thyroid at 41 mg/day? I thought this might be in one of the two papers you kindly provided links to, but I could not find anything re thyroid in these, and I have seen nothing suggesting this in any of the papers on natural forms of strontium that I have read. Would very much appreciate any references you have on this issue and will follow up and get back to you.
Li’s thesis also very nifty — I am assuming this was animal research, so results would need to be confirmed in human trials, but his suggestion that “calcium will supply nutrition for bone while strontium will display synergistic effects for enhancing bone formation activity” and confirmation via the finding that “Oral administration of strontium fortified calcium compound significantly increased expression of IGF-I and Runx2 in bone matrix. Both IGF-I and Runx2 levels were positively associated with the bone mineral apposition rate (MAR).” is really stellar. If there is a synergistic effect here, that might help explain the exceptional results seen when strontium is added to a bone building regimen.
Finally, I don’t know what your current BMD is or risk for osteoporosis because of the specifics regarding your health, but if you are at high risk for fracture, then taking the dose of strontium provided by Strontium Boost for 6 months, then testing, would be my suggestion. Once improvement has been made then dropping down to a lower dose, say half to one-quarter this amount, may be sufficient. Again, you would need to use the lower dose for 6 months and then recheck. As the daily dose of Strontium Boost is 4 capsules, it would be easy to cut down to half (2 caps) or 1/4 (1 capsule).


Hi Lara,

That makes sense about the calcium dosage. The label online didn’t say how often to take it. I did notice something interesting though; the D.V. for vitamin D is 400 IUs, but the labels for the plain and plus both show 100% of the D.V. when they have 1000 IUs and 800 IUs respectively? Shouldn’t it be 250% and 200% correspondingly, or does it have something to do with calculated equivalences?

The strontium and increase in thyroid weight, that I had reference to, can be found in the thesis paper (cited above) in one of the literature review portions. States the following:
“Strontium supplementation also increased thyroid-gland weight and decreased pituitary weight in rats, with a “no-observed-adverse-effect-level” roughly equivalent to 41 mg per day for humans.”

I found the study, with the PMID # for you that was referenced in the above dissertation.
Kroes, R., et al. Short-term toxicity of strontium chloride in rats. (1977) Toxicology V.7 p. 11-21. PMID:

What are your thoughts about the following quotation mentioned earlier from Li’s thesis paper? “Interestingly, according to one study, 170 mg of strontium per day was more effective than 680 mg per day for reducing fracture risk.”

As always thanks again for your insights.



Hi Lara:
I have just been reading some articles on antidepressants (SSRI, SNRI) causing bone loss which concerns me as I am taking one and have osteoporosis. Do you think the Algaecal and Boost can still build bone if one is on that type of medication? I just finished your book and found it very interesting and hopeful.

Thank you.

Lara Pizzorno

Hi Barbara,
You’re already ahead of the game since you are aware that the antidepressant you are taking causes bone loss. Since you may be using this drug for awhile, it is especially important that you be on the best bone-building program you can devise. AlgaeCal Plus and Strontium Boost are an excellent foundation for you — sea-alage derived calcium has been shown in research studies (both in vitro and in human trials) to be much more effective in promoting healthy bone remodeling than other forms of calcium, even calcium citrate, which is the better absorbed form of calcium derived from rock. Strontium both helps prevent bone loss and promotes the activity of the cells that build new bone. Just yesterday, in response to questions asked of me by Tyler here on AlgaeCal’s blog, I read a paper indicating the combination of calcium and strontium actually produces a synergistic effect. In other words, calcium works better for you when combined with strontium. Just be sure you are taking the full dose of AlgaeCal Plus (2 capsules twice daily) along with the Strontium. You want to always be consuming more calcium than strontium.
I don’t know anything else about you — your current bone density? whether you are premenopausal, perimenopausal or postmenopausal? Where you live– and thus how much sunshine is available to you year round and your likelihood of vitamin D deficiency? Whether you are eating a healthful diet? An unhealthy diet (processed foods, sugars, chemicals, refined grains, trans fats, GMO foods) with little fresh foods (vegetables, fruits, whole grains, nuts, seeds, omega-3 rich fish, etc.)will promote bone loss. Are you taking any other supplements? I would highly recommend you take a high potency multiple vitamin and mineral supplelment to ensure you are getting sufficient amounts of the B vitamins, vitamin C, A, E (make sure your supplement gives you mixed tocopherols, NOT just alpha tocopherol, which by itself promotes inflammation, which causes bone loss) and get your blood levels of vitamin D checked to be sure you are within a healthful range (60-80 ng/mL is considered optimal range now). Low levels of vitamin D are associated with depression as well as bone loss. The test is a simple blood draw, is not expensive and should be covered by your insurance. You have my book, Your Bones, which will help you navigate your way through determining exactly what YOU need. Feel free to write me if you have further questions. Bottom line here — YES, AlgaeCal Plus and Strontim Boost are especially important for you. Taking a drug that causes bone loss increases your need to do everything you can to at least maintain your current BMD. My hope for you is that following the program outlined in Your Bones (avoiding as many of the factors that contribute to bone loss as you can, eating very well, getting some bone-building exercise, and ensuring you are supplementing with the nutrients your diet may not be providing in sufficient amounts for your optimal health) will also enable you to — with your doctor’s help — no longer need the antidepressants. As I mentioned re vitamin D, many times, depression is due to nutrient insufficiencies. I wish you every possible goodness as the outcome from your current situation. Just let me know if you have further questions. Be well! Lara


Hi Lara:
Thank you so much for your response. I am very appreciative for all the information. I am doing many of the things you mentioned and have one more quick question. Will the trace minerals in AlgaeCal be enough on a daily basis or do I need to supplement?

Thank you again.

Lara Pizzorno

Hi Barbara,
Very glad to hear you are doing many of the things I noted that are essential for healthy bones. AlgaeCal’s content of trace minerals is excellent, however, no supplement can make up for lack of a healthy diet. Remember, supplements are just that — SUPPLEMENTS, not replacements for food. If you are consuming a Mediterranean-style diet rich in organically grown vegetables (esp leafy greens, whole grains, nuts [eg Brazil nuts are an excellent source of selenium — so good that you don’t want to consume more than 2 Brazil nuts a day]), then this combined with AlgaeCal Plus will be providing you with a good supply of trace minerals. Conventionally grown vegetables have been shown to contain far less of many minerals, so if you are not eating organic, all bets are off here. Hope this helps, Lara


Hi Lara,

Thanks again for your reply. That makes sense about the calcium dosage; the online label didn’t say how often to take it. I did notice something interesting on the label though. The D.V. for vitamin D is 400 IUs and the plain and plus give 1000 IUs and 800 IUs respectively, but they both say they deliver 100% of the D.V., shouldn’t it say 250% and 200% correspondingly? Or does it have something to do with calculated equivalences?

The information on the strontium/thyroid is found in the Li’s thesis paper cited above. It states the following:

“Strontium supplementation also increased thyroid-gland weight and decreased pituitary weight in rats, with a “no-observed-adverse-effect-level” roughly equivalent to 41 mg per day for humans”

Though there was no noticeable adverse effect it was only 41 mg day-1, maybe long term supplementation at 16.6 times that much could pose an issue.

I found the referenced study, with its PMID #, for you.
Kroes, R., et al. Short-term toxicity of strontium chloride in rats. Toxicology 7, 11-21. PMID: 841579


Lara Pizzorno

Hi Tyler,
In answer to your first question regarding the labeling on AlgaeCal’s calcium products, yes, they supply a little bit more than the DRI, but the DRI is considered insufficient by virtually all the experts in the field of vitamin D research.
DRIs for vitamin D are:
Children 1-13 years: 15 micrograms (600 IU)
Teenagers 14-18 years: 15 micrograms (600 IU)
Adults 19-70 years: 15 micrograms (600 IU)
Adults above 70 years: 20 micrograms (800 IU)
Pregnant and lactating women: 15 micrograms (600 IU)
Most medical authorities in the field of vitamin D research, e.g., Dr Michael Holick, also check the Vitamin D Council, recommend at least 2,000 IU/day. We have found the majority of patients we have screened need 5,000 IU /day or even more. The only way to know what YOU need is to run the blood test for 25(OH)D and see what your levels are — optimal level is considered to be 60-80 ng/mL.

Regarding strontium/thyroid — Thanks for sending me the PMID. I took a look at the study — this is one short term (90 day) rat study done back in 1977. I looked but could find no other study that has replicated these findings or reported similar findings since. If this had been a significant issue, SOMETHING further should have shown up by now. It has not. Even strontium ranelate (the drug version of strontium supplelmentation, which greatly increases risk for a variety of life-threatening side effects including DRESS syndrome and venous thromboemoblism) has not been linked to adverse effects on thyroid function. But I would strongly advise you NOT to use any dosage of this abnormal form of strontium!
I also found interesting the researchers comment that iodine insufficiency might have been a contributing factor. MANY people are deficient in iodine for a variety of reasons I summarized in a 2 part review paper I wrote on iodine for Longevity Medicine Review (here is a link to Part I – As I expect you know, our bodies cannot produce thyroid hormone without sufficient iodine (T4 requires 4 iodine molecules, T3 requires 3 of them). Many factors in our current environment prevent us from getting sufficient iodine for optimal thyroid function.
Still, none of the research that I have seen has ever mentioned any adverse effect on thyroid function from natural forms of strontium at a dosage level of 680 mg/day. Again, however, what you (and each of us) is concerned about is YOUR personal potential for adverse effect. If you have reason to believe YOUR thyroid function might be affected (e.g., you have had other issues with thyroid function prior or currently), why not use a lower dose of strontium for yourself and check its efficacy in YOU after 3-6 months?


Hi Lara,
Thanks again for your response. I am glad that AlgaeCal has lots of Vitamin D in it, I completely agree that the D.V of 400 and the DRI of 600 is way too low. I have seen a number of studies showing that unless the subjects took at least 800 IU’s of vitamin D there was no improvement in the measured parameters. I was just thinking that because AlgaeCal provides more than the DV, it should be reflected in the percentage given. Just as it gives the appropriate % of calcium and magnesium, I would think it would do the same for vitamin D. However, as mentioned the labels on both, the plain and plus, state they each contain 100% of the DV when in reality they contain 200% and 250% of the DV. Shouldn’t the label reflect the actual percentage?

I agree with your assumptions on thyroid and iodine—great article by the way, I hope others reading these posts will check it out—I felt the same way, but I wanted to ask you because I could see that you had already done an extensive amount of research and willing to answer peoples questions/concerns. I like it when people reach the same conclusions I have.

I mentioned this earlier, what are your thoughts on the following statement given in Li’s thesis paper (cited above):

“Interestingly, according to one study, 170 mg of strontium per day was more effective than 680 mg per day for reducing fracture risk (Meunier et al., 2002), which raises the possibility that even lower doses might be as effective as, or more effective than, the dosages that have been studied.”

Thanks again for your insights.

Lara Pizzorno

Hi Tyler,
I asked AlgaeCal for a response to your question and it appears that the reason is a legal issue. Originally, the labels were made just as you suggested, but for some legal reason, they were told 100% is maximum that should be stated for vitamin D. Also as I am sure you know, some “experts” are still saying 600-800 IU of vitamin D is the recommended amount – despite years of research and literally hundreds of studies now showing this is not the case. Bottom line here for practical purposes — i.e, YOUR HEALTH, it is not best to simply now rely on the RDI % to determine whether a supplement is providing what YOU need – particularly in the case of vitamin D, a blood test to check your levels of 25(OH)D is essential and should be run every 3-6 months for at least a year to get an indication of how the seasons affect YOUR vit D levels depending upon where YOU live, YOUR lifestyle, diet, genetics, etc.

RE strontium at a lower dose – I agree with you, and so does Dr. Wright. He is now telling his patients that once positive effects have been noted (say 3-6 months of 680 mg dose shown to be effective in the research) that they should drop this dose down to half this amount or even less.
However, no research that I know of specifically shows that 170 mg of strontium /day is more effective in preventing fracture risk, and the only PubMed article I can find for Meunier et al in 2002 concludes a 2 gram/day dose is most effective – here is the abstract:
(Is the sentence you quoted somewhere in the full paper? After reading the abstract, I did not pull the full article.)

J Clin Endocrinol Metab. 2002 May;87(5):2060-6.

Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis–a 2-year randomized placebo controlled trial.

Meunier PJ, Slosman DO, Delmas PD, Sebert JL, Brandi ML, Albanese C, Lorenc R, Pors-Nielsen S, De Vernejoul MC, Roces A, Reginster JY.


Hôpital Edouard Herriot, 69437 Lyon, France.


The aim of the strontium ranelate (SR) for treatment of osteoporosis (STRATOS) trial was to investigate the efficacy and safety of different doses of SR, a novel agent in the treatment of postmenopausal osteoporosis. A randomized, multicenter, double-blind, placebo-controlled trial was undertaken in 353 osteoporotic women with at least one previous vertebral fracture and a lumbar T-score <-2.4. Patients were randomized to receive placebo, 0.5 g, 1 g, or 2 g SR/d for 2 yr. The primary efficacy endpoint was lumbar bone mineral density (BMD), assessed by dual-energy x-ray absorptiometry. Secondary outcome measures included femoral BMD, incidence of new vertebral deformities, and biochemical markers of bone metabolism. Lumbar BMD, adjusted for bone strontium content, increased in a dose-dependent manner in the intention-to-treat population: mean annual slope increased from 1.4% with 0.5 g/d SR to 3.0% with 2 g/d SR, which was significantly higher than placebo (P < 0.01). There was a significant reduction in the number of patients experiencing new vertebral deformities in the second year of treatment with 2 g/d SR [relative risk 0.56; 95% confidence interval (0.35; 0.89)]. In the 2 g/d group, there was a significant increase in serum levels of bone alkaline phosphatase, whereas urinary excretion of cross-linked N-telopeptide, a marker of bone resorption, was lower with SR than with placebo. All tested doses were well tolerated; the 2 g/d dose was considered to offer the best combination of efficacy and safety. In conclusion, SR therapy increased vertebral BMD and reduced the incidence of vertebral fractures.

PMID: 11994341


Hi Lara,
I have had to take large doses of Prednisone and then varying amounts over years so have severe osteoporosis.
I stopped taking Fosamax but my Dr. wants me to continue. What would be the risk of taking some Strongtium while on Fosamax?
My Dr. says he knows nothing about Strongtium.

Lara Pizzorno

Hi John,
Strontium citrate (PLEASE be sure to use strontium citrate NOT the drug strontium ranelate, which increases risk significantly for several life-threatening side effects) may be helpful to you and is definitely preferable to Fosamax. For your best chance of reversing your osteoporosis and building healthy new bone, you absolutely must ensure you are consuming optimal amounts of all the nutrients required for bone health, both from your diet and supplements, and are eating a very healthful diet, also getting some weight bearing exercise. If you have not read my book, Your Bones, I urge you to get a copy (your library should have it if you do not want to purchase one, but it is available on Amazon for less than $10) and get informed about what your bones need to repair, how to figure out how much of each nutrient YOU are getting from your diet and thus how much YOU need to supplement. Everything in the book applies to men as well as women, and it also includes a section on specific issues for men. If your osteoporosis has progressed to the point that you need weight bearing exercises that are safe for someone with increased risk of fracture, please check into Pilates (You will need to work with a STOTT Pilates instructor certified in the use of Pilates for osteoporosis). Have your doctor read these medical journal articles and get informed! If he refuses to get informed, get another doctor who is educated and willing to help you:
Gosch M, Jeske M, Kammerlander C, et al. Osteoporosis and polypharmacy.Z Gerontol Geriatr. 2012 Aug;45(6):450-454.PMID: 22806642
Le Goff B, Guillot P, Glémarec J, et al. A comparison between bisphosphonates and other treatments for osteoporosis.Curr Pharm Des. 2010;16(27):3037-44.PMID: 20722614
Uebelhart D, Frey D, Frey-Rindova P, et al. [Therapy of osteoporosis: bisphosphonates, SERM’s, teriparatide and strontium].Z Rheumatol. 2003 Dec;62(6):512-7.PMID: 14685711


Hi Lara,
Thanks for the info on Vitamin D. That’s interesting that it was advised to only state 100%, but in some ways isn’t surprising.

Re-low dose strontium the statement:

“Interestingly, according to one study, 170 mg of strontium per day was more effective than 680 mg per day for reducing fracture risk (Meunier et al., 2002), which raises the possibility that even lower doses might be as effective as, or more effective than, the dosages that have been studied.”

Is a direct quotation from Li’s thesis paper cited above on page 41 of the document or page 59 in the PDF format, if you just scroll down to page 41 or type in page 59 or search “more effective than” you will find it.

Also Dr. Keith Scott Mumby, is saying the same thing, found near the bottom under strontium.

Hope that helps thanks again!

Lara Pizzorno

Hi Tyler,
Thanks, I found the reference to this study in Li’s thesis — unfortunately, Li does not provide us with a footnote on it, just one for the 2004 paper by Meunier et al. I read French, so read this paper; it says nothing about strontium dosages. I looked at Dr. Mumby’s article — he also provides no references (and I sure wish he had specified the type of vitamin K2 he is referring to when suggesting a 10 milligram daily dose is MK-4! And also that the effective dose for MK-4 in the research is 45 mg/day [actually 15 mg taken 3 times daily]. You do NOT want to take 10 milligrams of MK-7 daily! Just 100 micrograms of MK-7 is effective.) Thus, I am unable to read the paper in which 170 mg of strontium is said to be more effective, so I do not know what was done and cannot give you more helpful feedback on this. If you can locate this paper, please do let me know. Sorry that I have not been able to find it on PubMed.


Hi Lara,

For that quotation out of Li’s thesis article he cites Meunier as the author of the study, and cites him twice :

This is the 2004 article
Meunier, P. J., Roux, C., Seeman, E., Ortolani, S., Badurski, J. E., Spector, T. D.,
Cannata, J., Balogh, A., Lemmel, E. M., Pors-Nielsen, S., Rizzoli, R., Genant, H.
K., and Reginster, J. Y. (2004). The effects of strontium ranelate on the risk of
vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med
350, 459-468.
Here is the link:

Here is his 2002 article which is the one being cited. And already you posted the abstract above.
Meunier, P. J., Slosman, D. O., Delmas, P. D., Sebert, J. L., Brandi, M. L.,
Albanese, C., Lorenc, R., Pors-Nielsen, S., De Vernejoul, M. C., Roces, A., and
Reginster, J. Y. (2002). Strontium ranelate: dose-dependent effects in established
postmenopausal vertebral osteoporosis–a 2-year randomized placebo controlled
trial. J Clin Endocrinol Metab 87, 2060-2066.
Here is the link:

Which one did you get in French? Perhaps the information in Li’s thesis article was cited inaccurately? as this happens from time to time.

Lara Pizzorno

Hi Tyler,
Here’s the 2004 paper that came up when I ran a PubMed search for Meunier PJ:

Med Sci (Paris). 2004 Jun-Jul;20(6-7):631-3.

[Strontium ranelate: new therapeutic agent for postmenopausal osteoporosis].

[Article in French]

Meunier PJ.

PMID: 15329809 [PubMed – indexed for MEDLINE] Free full text

I just ran a PubMed search for Meunier PJ 2002 again, and the article appeared — I have no idea why it did not come up for me when I checked earlier. WEIRD!
So, I have finally read the paper — but I found no mention of a 170 mg dose of strontium being used. I ran a search within the paper to be sure, and nothing came up for 170 mg. The dosages given in the 2002 paper were 0.5 gram, 1 gram or 2 grams/day for 2 years, and best results were seen with 2 gram dose.

Regardless, I still think you are correct in suggesting a lower than 680 mg/day dose of strontium citrate may be helpful. In those with osteoporosis or osteopenia, I would suggest 6 months to a year at the 680 mg dose, then once benefit has been verified with DXA, discussing with their physician the possibility of lowering the dose and rechecking in 6 – 8 months.

One other thought — have you considered trying to contact Li and asking him for a link to the research in which 170 mg of strontium was used successfully? I looked again at his thesis, but could find no contact information there. Would you have access to a means of contacting Li through the HKU Scholars Hub?

Mary Bomford

Hi Lara
I want to share my new way to eat natto as it is not an easy food for westerners to eat! Getting adequate vitamin K2 is clearly important for maintaining bone strength but not everyone can afford to get K2 from supplements and getting adequate K2 from natural foods is not easy either. Japanese Natto (fermented soybeans) has extremely high concentrations of vitamin K2 and packets of frozen natto are available at low cost from Asian food shops. But natto has a very strong smell and a slimy texture and most westerners don’t like it. I bought some and was determined to eat it regularly. But I really struggled with smell and the slimy coating. So now I have a new way of eating it which does not have this problem. I eat it frozen!!! I just break off bite size frozen pieces, crunch them up in my mouth quickly and swallow them with a mouthful of hot tea. I actually enjoy eating natto this way and look forward to it. I’m going to go and eat some now as I am determined to keep my bones strong!!!


Hi Lara,

Thanks so much for looking into all that. You have been so nice, I actually feel kind of bad for giving you a headache over the above contested quotation from Li’s thesis paper. I must be honest with you, I have done a lot of research with strontium and when I read Li’s thesis paper I was surprised that he was suggesting 170 mg to be more effective. I read the article by Meunier that he cited, but it was evident that said article supported 680 mg not 170 mg to be the most effective.

I then searched a series of database/citation indexes (e.g. PubMed, Web of Science, Scopus, HighWire and Google scholar) for all the articles by Meunier and found over 150 articles relating to strontium in which he was involved. None of the articles however, showed 170 mg to be more effective than 680 mg.

I then came across Dr. Keith Scott Mumby’s article which said 170 mg is more effective. I also came across Dr. Don Colbert’s article which also said that 170 mg is more effective and he cited Meunier (same reference that Li gave) for the information.

This made me go back through all the articles and recheck them more punctiliously; I also did some stoichiometry based on the molar masses of strontium and the various anions to see if the discrepancy could be reconciled by various methods used to report dosage (i.e. elemental vs. compound). Indeed the 500 mg of strontium ranelate (used in Meunier study) is equivalent to 170 mg of elemental strontium, and 2 grams of the compound equates to 680 mg of strontium. I searched the literature again for equivalent doses of 170 mg elemental strontium, in every case the higher dose was shown to be more efficacious.

However, I did come across one article using what they called “low dose” strontium phosphate, that may lend support. But the article was not clear on the elemental dosage of strontium because they only gave the molecular weight in compound form. It was impossible to calculate the elemental dosage because they didn’t provide the molar-mas of the compound. So I made the assumption that the formula was strontium di-calcium phosphate (in which case the molar mass=357.7 g/mole). I couldn’t know for sure if this is the correct molar mass, because there is nowhere for an extra divalent ion (i.e. strontium) to bind to Ca3(PO4)2. (So it could have been di-Sr, a mixture or something else.) With that assumption the results indicated that around 400 mg of strontium was very effective, but this is still higher than 170 mg.

I then decided to e-mail the authors; I asked Li, Doctors Mumby and Colbert, about the discrepancy. I also e-mailed Meunier and asked if his cited study (or any he knew of) suggested 170 mg to be more effective than 680 mg—as the above people are citing him as demonstrating that.

In waiting for their reply, I came across this blog and noticed you not only had done an extensive amount of research on strontium, but you were answering everyone’s questions. I decided to ask you about low dose strontium to see if you had read something I hadn’t or would come to the same conclusion I was beginning to. It has now been 3 weeks and I have received no response by any of the authors. I am surprised that Meuiner didn’t get back to me—his actual email address is different than the one given in the articles, in fact the one given doesn’t even work, luckily I found his actual contact info.

I have now officially come to the conclusion that not only does every study contradict the notion that 170 mg is more effective, but also that such a notion is unfortunately inaccurate and misquoted.

Again, Lara sorry for giving you a headache with this strontium dosage, and thanks so much for your help in investigating this matter with me, if any of those authors emails me back I will let you know.


Lara Pizzorno

Hey Tyler,
What a great insight of yours! Of course, the elemental vs. compound difference can explain the seeming dosage discrepancy. Nonetheless, from the papers I have read, 170 mg of elemental strontium has not been shown to be more effective in rebuilding bone — although even the longer studies looked at no more than 2 years if I remember correctly. So, they were looking at short term (in comparison to the rest of a postmenopausal woman’s life span) outcomes. The question I have is — would this lower dosage be a better long-term choice after initial improvements? As you know, our bones continue to remodel throughout our lives, so the therapies used to support healthy bones must be ones we can rely on long-term. I have discussed this isssue now with a number of physicians — docs whom I feel are among the smartest on the planet — and all are in agreement that 680 mg may not be the best long-term choice. So, the issue you bring up is an imporant and valid one.

Personally, I expect to no longer be even borderline osteopenic by my next DXA (about 9 months from now)– and as soon as that happens, I am going to run an n=1 trial, cut my strontium dosage in half and see how that works for me.

Please don’t apologize for asking such interesting questions, especially since the answers to them could have very significant practical relevance for human health. Our correspondence has been a total delight for me. Don’t be discouraged not to have heard back yet from Li, Mumby or Colbert — I expect all have many demands on their time. I have corresponded with a number of leading researchers. In both the review articles I have written on a variety of topics on Longevity Medicine Review and as I was writing Your Bones, I have had quite a few questions for which I could not find answers in the published research, so I wrote the people whose published work indicated they were the seminal researchers involved. Some responded quickly;others took several months to get back to me — but all responded eventually and have been most helpful.

Keep asking questions! And stay gloriously well,


Thanks Lara,

I have asked questions on a number of different blogs or emails to companies and it seems like my posts/emails usually get rejected/or no response, probably because I asked questions that couldn’t be accurately answered and thus demonstrated the fallaciousness of the product/marketing claims. Luckily, strontium has science to back it up and someone (i.e. you) knowledgeable to answer questions concerning it.

I currently agree that after taking the higher strontium dosage until the desired results (with corrections of overestimation—based on the attenuation coefficient—due to the larger ionic radius of strontium—as you said above) that a lower dosage would be desirable. As already mentioned, we know that lower doses are still effective just not as effective, so taking the lower doses would be advisable after the temporary period of higher doses. I think this is good advice especially if the patient has impaired renal function and thus subsequent decrease in its clearance by the kidney.

Thanks again!

JoAnn Rice

I do not see anything written about the dosage one should take for Strontium Citrate? and how many times a day? I was thinking of ordering mine from Vita Cost but see brands. Any thought?? Thank you JoAnn Rice

JoAnn Rice

Oh my…my face is red! I did not read far enough for all the questions and answers. You all have been so helpful to me as I just found out about strontium.
I am 77 yrs. old and have been diagonosed with osteoporosis at least 13 yrs. ago. I was on Fosamax for 10 years and went off 2 years ago at my request.
I had a complete hysterectomy (ovaries also) when I was 42. I have always been very active but not much formal exercise until 3 years ago. I did different video’s of aerobics and yoga on my own over the years.
I have found this website to be most interesting and informative. I plan to start on strontium as soon as possible and have so much more knowledge on the dosage and when to take as I too am on levothyroxine.

I just had a dexa scan with my spine at 3.5, a slight increase from 2 years ago. My endocrinology/osteoporosis specialist wants to start me on one of the newer drugs (not Fosomax) and I really do not want to. I am just so happy to find out about strontium and ready to get going with this.

I thank you all so much. I will continue to read this site, get the Bones book (and read it) and get back intouch with you later to report my progress.


Lara Pizzorno

Hi JoAnn,
Very glad you found the information helpful. PLEASE read Your Bones — you can check it out from the library if you do not want to purchase it, but it costs less than $10 — publisher is a non-profit and has made the book as inexpensive as possible. I discuss all the nutrients you need for healthy bones, what forms are best and how to determine how much YOU are getting from your diet and how much you need from supplements. Also discuss the many contributing factors to bone loss, the vast majority of which we can avoid or at least minimize our exposure to — and you may be surprised by some of them. I certainly was.
I’ve recently seen studies indicating that if your dose of levothyroxine is either too high or too low, this can contribute to bone loss. Best to have your doctor check your levels of the thyroid hormones (free T4 and free T3) to ensure your current dosage is correct.
Be well, Lara

Derek O’Brien

Lara, Congratulation for such an all-encompassing website on getting our bones back to how they should be, and avoiding the dangers of some pharmaceuticals. I wish others would follow your lead and not become lured away by the Woo and the mystic. Poor Vivienne, she was good at first, but began drifting away from the science and became intoxicated with the Woo. It is strange how the US education system induces so much self esteem that people really believe their own BS and make such hilarious statements as does poor old Robert Young, might be the religion in his case.

You answered all the questions regarding strontium citrate for me, and sank the misinformation regarding it causing blood clots, very grateful for that. About 12 months ago I was taking 340 mgm caps, 1 a day, for 120 days, stopped because of possible blood clot risk, and now know that was unnecessary, so after tomorrows DEXA I will resume. Yes, have low BM/osteo, had used Fosamax for many years in the past, and after pelvic fracture from fall caused by tripping, stopped Fosamax as I considered it embrittled my bone, the fall was not very severe, but still caused fracture of the pubic ramus.

Realise that I should increase leafy greens to improve calcium intake, eat meat (chicken mainly)but do eat a lot of cheese, and a couple of litres of milk lasts 3 days, used mainly on breakfast of oat bran, shredded coconut and chia seeds, as well as a small glass of milk at bedtime, use calcium/magnesium supplement twice a day (Ca 230 mgm. Mg 116 mgm) 6000 IU D3 a day, C 2 gm a day, Selenium 400 mcg a day, K1 L2 (LEF Super K) 2 caps + assorted other vitamins at high dosage. Have not had a cold or flu for 2 years since beginning this dosage of vitamins etc. Must be on the right track, as no vaccinations either.

Hmmm, rabbitted on a bit, sorry. Keep with the science. Best wishes.

Lara Pizzorno

Thanks so much Derek. I so appreciate your very kind words and that you took the time to write means a lot — you inspire me to keep at it. My modus operandi is to report what is in the peer-reviewed medical literature — definitely non-Woo. Your current program looks helpful. A couple of suggestions you might consider: ensure that the meat (chicken or other) is from free-range, organically grown chicken. The research coming out on GMO foods is scary — GMO corn and alfalfa is used to feed conventionally grown cows, chickens eat corn, etc. This plus the feedlots for the cows and cages for the chickens makes me unwilling to recommend eating anything produced from either. Re the GMO aspect, I would avoid totally anything GMO until we know a lot more. Also the cheese and other dairy products you consume should be full fat and made from the milk of pastured cows (“pastured” meaning allowed to eat grass). Low fat and fat free dairy products contain virtually no K2; those made from pastured animals [also eggs from free range hens] are MUCH higher in this essential bone and cardiovascular health nutrient. The fat-soluble vitamins D3, K2 and A (retinoic acid, not beta-carotene) are all essential for bone health and must be in balance as they work together to get the job of keeping you healthy done. Vit D increases your absorption of calcium and also the production of the proteins responsible for putting calcium into your bones and keeping it out of your arteries, kidneys, etc. These proteins –osteocalcin and matrix Gla protein, respectively — are vitamin K dependent — i.e., they are activated by vitamin K, so when you take vit D you REALLY need to be sure yo have enough vit K around. Vit A ensures that you do not over produce osteocalcin and matrix Gla protein and thus create a functional vit K deficiency for yourself. I’ve written a number of articles on Longevity Medicine Review re vitamins A, K and D, all of which discuss aspects of their inter-workings. You can check these out by going to the archive on LMR — its free access at SO –I suggest you consider adding vitamin A (at least 3,000 IU to 5,000 IU per day) to your regimen. This would be quite safe — the UL for vitmain A, which I believe is way too low, is 70,000 IU per week, so at 5,000 IU/day, you would only be taking 35,000 IU/wk.
One last comment re calcium — I personally rely on AlgaeCal for my supplemental calcium because it is not just calcium, but calcium in the matrix of all the trace minerals utilized by the sea algae to create its bony structure. A number of trace minerals are involved in building bone. Our diets are often lacking in trace minerals because of the way Big Farma has changed agricultural practices, so the content of many trace minerals has become depleted in our soils, in the plants grown in them and in the animals that eat these plants (including homo sapiens!). I wrote about this in Your Bones in detail and reference quite a few recent studies confirming it. AlgaeCal can help rectify this trace mineral gap.

Stay well, Lara

Derek O’Brien

Lara, Thanks for the extra git you gave, much appreciated.

We are lucky here in Australia, our dairy is virtually all green-grass grazing, much of our beef is too, especially when obtained from the local butcher and not the supermarket; can get free-range chickens cooked to perfection locally, lamb is always green-grass grazed, but pork is a mystery due to production methods, and if I choose to eat seasonal fruit and vegetables organic, I am happy as a lark. Low incidence of GMO foods, but the rubbish is sneaking in, our politicians, all being lawyers, plus an occasional farmer, make stupid scientific decisions, so GMOs are getting in.

Items left from my list of meds: Super Ubiquinol CoQ10 from LEF, Zinc 22 mgm, Chromium 50 mcg, daily and copper 2mg twice a week; manganese is picked up from CA/Mg supplement. Waiting for delivery of Vanadium.

Yes, all dairy is full cream, yogurt and NZ Cheddar cheese; unfortunately milk is homo/pasteurised and fresh is unobtainable. And basically following a low carb diet otherwise. With exercise, this is reducing the overweight problem and settling a diabetic tendency by assisting metformin; blood sugar is very well in control.

I will look into the Algaecal when my stock of Ca/Mg supps gets down to reorder level.

Take care.

DEXA rescheduled, machine was out of action this morning.

Lara Pizzorno

Australia — truly one of the loveliest places on Earth. You are so lucky to live there! We’ve visited a couple of times — we have friends at Southern Cross University and my husband, Dr. Joe Pizzorno, has lectured there. We fell in love with Australia, both the land and the wonderful people. Still hoping to get back for another visit to Brampton Island where we swam in lagoons and were surrounded by clouds of electric blue butterflies–am I remembering how to spell this correctly?
Sounds like you are doing lots of good things for not only your bones, but your health overall. Hope you will let me know how your DXA turns out. Expect results will be good. Re AlgaeCal — adding this form of supplemental calcium to my regimen made a HUGE difference for me. I had been rebuilding bone, but slowly. Within 10 months of using AlgaeCal Plus, my 2012 DXA showed BMD ↑3.2% in my hip, and ↑6% in my spine from 2011. Since switching to AlgaeCal was the ONLY thing I changed in what I had been doing, I am now a believer. I hope you will give AlgaeCal a try when you need to reorder you calcium supps.
Stay gloriously well, Lara

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Hi Laura, You recommended calcium citrate, malate, gluconate, aspartate, or hydroxyapatite over calcium carbonate in calcium supplements, yet calcium carbonate appears to be the major form of calcium found in the algae used in Algaecal. What is your your opinion on the effectiveness of this supplement over calcium carbonate? The information on Algaecal sounds good, but I would like to hear a recommendation fom someone besides the people selling the product. Thanks!

Lara Pizzorno

Hi Carol,
AlgaeCal actually contains several forms of calcium — calcium hydroxide, chloride, phosphate and sulfate in addition to carbonate. I’ve seen the independent lab analysis. Why do I believe AlgaeCal is more effective than plain calcium carbonate? I read the research. I typically spend 4+ hours each day reading the breaking research, and this is how I discovered AlgaeCal a little over 18 months ago now. Research conducted by AlgaeCal (which BTW is VERY unusual since supplements of natural compounds cannot be patented, so very few companies spend the $ on research), pitting its algae-derived calcium against calcium carbonate and calcium citrate in head to head studies — a human osteoblast study and two human studies — convinced me to try it.
In the in vitro research, AlgaeCal produced 200 – 400% greater proliferation and mineralization of osteoblasts (bone building cells) than did calcium carbonate or citrate. In AlgaeCal-treated cells, levels of PCNA (proliferating cell nuclear antigen, a protein involved in DNA synthesis and repair) and DNA synthesis were also much greater (4.0-fold greater than control, 3.0-fold greater than calcium carbonate, and 4.0-fold greater than calcium citrate). The end result was that more calcium (Ca2+) was deposited in AlgaeCal treated cells (2.0-fold more than controls, 1.0-fold more than calcium carbonate, and 4.0-fold more than calcium citrate-treated cells). When vitamin D3 was also added to the treated osteoblasts, the results were even better.
AlgaeCal was also found to significantly reduce oxidative stress in the osteoblasts after just 24 hours. (Oxidative stress promotes inflammation, which then triggers osteoclasts, the specialized cells that break down bone, to spring into action.) AlgaeCal reduced oxidative stress in human osteoblasts by 4-fold compared to controls (untreated cells), 2-fold compared to calcium carbonate, and 2.5-fold compared to calcium citrate.
These promising results led to 2 human trials, in which results were excellent. 2 versions of AlgaeCal supplements were used– AlgaeCal 1 and AlgaeCal 2. To put these results into perspective, you should know that the “conservative” (least) expected drop in BMD for women aged 41-55 is a loss of -0.5%/year, for women 56 and older, a loss of -1.0%/year, and for men, a loss of half these amounts. However, population-based longitudinal studies suggest that these loss estimates are not high enough. Minor bone loss starts at age 40, increasing to 0.5% to 0.9% a year in peri-menopausal women and to above 1% after menopause, after which the yearly loss in BMD remains about 1%. Other studies suggest that after midlife, in men as well as women, there is an age-related yearly loss of bone of 1%, which, for women, accelerates to 2% for up to 14 years around the age of menopause (which typically occurs around age 52). In men, a small loss is detected in 40-year olds, which increases to a loss of about -0.8% per year into old age.
Compared to the most conservative estimate for annual bone loss given above, AlgaeCal 1 had a positive mean annualized percent change (MAPC) in BMD of a gain of +1.15%. AlgaeCal 2 had a positive MAPC of +2.79%. With no negative side effects. No clinically significant changes in a 43-panel blood chemistry test were found, and neither group reported even one adverse effect.
Upon completion of this initial study, a second study was done to look at the effects of three different versions of an AlgaeCal bone-health supplement program. In this study, 176 women over 40 years of age followed one of three different bone-health programs: Plan 1 used a bone-health supplement with vitamin D3 (800 IU), AlgaeCal’s plant-sourced form of calcium (720 mg), and vitamin K as MK-4 (1.5 mg) for one year. The other two Plans also used AlgaeCal’s plant calcium, but in differing amounts (750 mg in Plan 2, 756 mg in Plan 3), and with differing amounts of vitamin D3 ( 1,000 IU in Plan 2; 1,600 IU in Plan 3) and other bone health ingredients. Most importantly, vitamin K2 was not used in Plan 2, but was included in Plan 3 as MK-7 (100 mcg). Upon completion of this initial study, a second study was done to look at the effects of three different versions of an AlgaeCal bone-health supplement program.
After this, a second human trial was run. In this study, 176 women over 40 years of age followed one of three different bone-health programs: Plan 1 used a bone-health supplement with vitamin D3 (800 IU), AlgaeCal’s plant-sourced form of calcium (720 mg), and vitamin K as MK-4 (1.5 mg) for one year. The other two Plans also used AlgaeCal’s plant calcium, but in differing amounts (750 mg in Plan 2, 756 mg in Plan 3), and with differing amounts of vitamin D3 ( 1,000 IU in Plan 2; 1,600 IU in Plan 3) and other bone health ingredients. Most importantly, vitamin K2 was not used in Plan 2, but was included in Plan 3 as MK-7 (100 mcg). All three AlgaeCal Plans tested produced increases in BMD — a marked improvement over just slowing the rate of age-related bone loss. In all three treatment groups, study participants with above average compliance had significantly greater increases in BMD compared to the losses seen in the two expected-change reference groups. Women in the Plan 3 group, the group receiving the most nutritionally comprehensive supplement program (the one now available at, gained significantly more BMD than the other two groups. Subjects in all three plans had an increase in BMD: Plan 1= +1.20%, Plan 2= + 0.33%, and Plan 3= +2.5%. Again, no adverse effects were reported nor were any seen in the comprehensive blood chemistry tests run on study participants.
After reading these papers (which were published in the peer-reivewed medical literature and are accessible on PubMed), I decided to try AlgaeCal. My results have been excellent — after 10 months of using AlgaeCal as my source of supplemental calcium, I had my DXA run. BMD in my hip/femur had gone up 3.5% and was up 6% in my spine. Prior to using AlgaeCal, I had been rebuilding bone, but SLOWLY. Now I am barely osteopenic and expect my next DXA will show I am fully in the healthy “normal” range. My results have convinced me that AlgaeCal is the calcium supplement I am going to continue to use. Why is it so much more effective? My guess is related to the research I am now seeing indicating how important a variety of trace minerals are to healthy bone remodeling — and these trace minerals are supplied naturally in AlgaeCal. It is NOT just calcium, but calcium within the matrix of all the trace minerals required by the sea algae to build its bony structure.
I hope this information is helpful to you and encourages you to give AlgaeCal a try. I am NOT paid by AlgaeCal to promote its products. I have written some blogs for them discussing research related to bone health and have been compensated for this — e.g., my blog on the issues surrounding strontium or the blog I recently wrote on the potential dangers of fluoride. But let me reiterate, I am NOT paid to be a sales person for AlgaeCal. I use it because it works.

Sylvia Ross

Hi Lara –
I just found this forum – thanks for all of the very interesting replies you have so kindly written. I have “Your Bones” on my Kindle now so I am reading (but must admit at my age I do forget rather quickly …so sometimes need to re-read..) How did your DEXA tests turn out after being on AlgaeCal?
I am Canadian and the BMD test shows lumbar spine T-score of -2.8 and Femoral neck T-score of – 1.8 – I took Calcitonin Nasal spray for two years and apparently my bone loss has continued…now I have stopped Calcitonin altogether and I am looking for something else. Your indepth info on Strontium Citrate has me leaning that direction….. but when I came across this info from you about AlgaeCal I thought it was worth considering…so my dear, I am asking how are your bones now ?
What do you recommend for me – age 74 with fine bones…and osteoporosis with the above BMD results? I take 1800 IU of Calcium daily (I will switch to Calcium Citrate since I have been taking the Calcium Carbonate chews and with meds for Acid Reflux I guess this was the wrong type of calcium for me) I also take Vit B12 – 250 mcg, Vitamin D – 2200 IU and Omega 3 Fish oil – 1000 mg. It would be nice to just swallow one pill – that would help bones and all else!
Many thanks Lara and any suggestions would be appreciated.

Lara Pizzorno

Hi Sylvia,
Delighted you are finding the information in Your Bones annd here on AlgaeCal’s blog helpful. As you work your way through Your Bones, I hope you will use it to figure out how much your diet is providing for you of the nutrients essential for building healthy bones and what and how much you will need to get from supplements.
Don’t know where you live in Canada, but if anywhere near Vancouver, BC, I will be giving 5 “Wellness Series” lectures for Factors Group discussing bone health in Vancouver Oct 22-24. I believe these are open to the public. Would love to meet you if you live anywhere near.
Personally, I take a good high-potency multiple (6 capsules is the daily dose), AlgaeCal Plus (for additional supplemental calcium, magnesium, D3 and K2) and Strontium Boost. Because of my genetic inheritance, which includes faulty vitamin D receptors, I need even more vitamin D3 and therefore more K2 (D3 and K2 need to be in balance), so I take extra of these as well, also take some vitamin A (another fat-soluble nutrient that works with and must be in balance with vitamins D and K) and omega-3s (and try to eat salmon at least once a week). I sure wish I could just take 1 pill, but reality is that this would not do the job for me. Every woman in my family whom I know about for many generations back died from osteoporosis — I am the poster child for risk for this disease, but have managed to beat it by learning what my bones need and supplying it. And if I can beat it, truly, anyone can!
I began taking AlgaeCal after coming across the research — 2 in vitro trials and 2 human trials — conducted on their products and published in the peer-reviewed medical literature about 2 years ago now. As a medical editor/writer, I typically spend 3-4 hours every day scanning the research and bone health is my special interest, so that’s how I learned about AlgaeCal. My results have been excellent — after 10 months of using AlgaeCal as my source of supplemental calcium, I had my DXA run. BMD in my hip/femur had gone up 3.5% and was up 6% in my spine. Prior to using AlgaeCal, I had been rebuilding bone, but SLOWLY. Now I am barely osteopenic and expect my next DXA will show I am fully in the healthy “normal” range. My results have convinced me that AlgaeCal is the calcium supplement I am going to continue to use. Why is it so much more effective? My guess is related to the research I am now seeing indicating how important a variety of trace minerals are to healthy bone remodeling — and these trace minerals are supplied naturally in AlgaeCal. It is NOT just calcium, but calcium within the matrix of all the trace minerals required by the sea algae to build its bony structure.
I hope this information is helpful to you and encourages you to give AlgaeCal a try. FYI — I am NOT paid by AlgaeCal to promote its products. I am not being paid to respond to questions here on this blog. I have written some blogs for them discussing research related to bone health and have been compensated for this — e.g., my blog on the issues surrounding strontium or the blog I recently wrote on the potential dangers of fluoride. But let me reiterate, I am NOT paid to be a sales person for AlgaeCal. I use it because it works.


Thanks, Laura, for your prompt and very detailed reply. In August 2011, my T score was -2.6 hip, -2.1 spine, and my doctor strongly suggested that I take Reclast. I am 57-years-old and have been resisting this advice since I was diagnosed with osteopaenia when I was 51. I would love to find a safe, effective, and natural way to increase my bone density and bone strength. I had a partial esophagectomy/gastrectomy 16 years ago due to esophageal cancer and, therefore, need to get a lot of my nutrients from supplements. It is overwhelming me to find the right combination of products that will give me the amount of vitamins and minerals recommended to maintain my health, as well as improve my bone density and bone health. In addition, Algaecal suggests taking Strontium Boost along with Algaecal Plus. I have already purchased Dr’s Best Strontium Bone Maker (Strontium Citrate), and wonder if, in your opinion, Strontium Boost is a better product. Thanks again for your help.

Lara Pizzorno

Hi Carol,
You’re so welcome! Yes, very challenging to work out the optimal amounts of vitamins and minerals we each need, and especially with all you have gone through, even more so.
In Your Bones, I’ve laid out how you can figure out what you are getting from your diet and then what the supplement options are, so you can better determine what you need. If you don’t have the book, your library should have it, so you can check it out without having to buy it — although it costs less than $10 on Amazon these days. Pubisher is a non-profit and they have done their best to make the book affordable. If you haven’t read it, please consider doing so.
Re strontium –any strontium citrate supplement should be good. I do not personally know anything about Dr’s Best quality control, so I cannot vouch for this company. You could contact them and ask them what they do to ensure their products are free of heavy metals and other contaminants. If they have good independent quality control assurances, then their strontium citrate product should be fine. I do know about AlgaeCal and can personally tell you their quality control is excellent.
Be well! Lara


I have read your recommendation for taking AlgaeCal . I am presently taking New Chapter Bone Strength Take Care. The calcium source from this brand is also algae as is the source for all the nutrients listed. Are you familiar with this brand? How does it compare to the AlgaeCal that you recommend?

Lara Pizzorno

Hi smlhealth,
There are a number of important to me differences between the algae used in New Chapter Bone Strength Take Care (Aquamin) and that which is used for AlgaeCal (Algas calcareus). Aquamin is a different species of algae from Algas Calcareas. Aquamin (used in New Chapter) has no published studies supporting its efficacy in promoting increases in bone density. AlgaeCal has 2 in vitro and 2 human clinical trials proving its effectiveness. New Chapter’s algae is sourced by dredging in the North Atlantic; dredging is harmful to the coral and the sea floor environment, and the dredging equipment has a huge nozzle so picks up a LOT more than just sea algae. AlgaeCal is gathered carefully by hand from the shoreline off the coast of South America (where it washes up) or from the sea floor by divers. This is a pristine environment, and AlgaeCal does everything possible to keep it that way.

Aquamin costs less than AlgaeCal –Why? Here are a number of reasons:

AlgaeCal is a tropical species / Aquamin is a North Atlantic species
AlgaeCal is live and phyto-nutrient rich / Aquamin is dead and decaying
AlgaeCal has a US FDA issued NDIN (dietary ingredient notification) / Aquamin has no NDIN, is not legally for sale in USA
AlgaeCal has done and published six safety studies / Aquamin has one unpublished safety study
AlgaeCal is USDA Certified Organic / Aquamin is not organic
AlageCal is harvested sustainably as evidenced by IBD and IBAMA / Aquamin is not sustainable as evidenced by their move from Ireland to Iceland for harvesting
AlgaeCal is ecologically Harvested by hand / Aquamin is harvested via dredging, which silts flora and fauna
AlgaeCal is a pure algae product / for Aquamin, *80% of material brought on to the large dredgeing ship is discarded as impure
AlgaeCal is untreated as it is clean and pure / Aquamin is bleached with Hydrogen Peroxide
AlgaeCal is clinically Supported for bone health:
•the only Ca complex to increase bone density in adults!
Health Canada claim pending.
•better absorption than CaCO3
•2X better mineralization of Osteoblasts than CaCO3 and Ca Citrate
•3X better proliferation of Osteoblasts than CaCO3 and Ca Citrate

Aquamin has no valid studies on bone health. Aquamin has done one “absorption study” where PTH response is measured. Because PTH exhibits an exaggerated response to any calcium, it is not considered a valid measurement by researchers in bone health. This is the only study Aquamin offer’s on bone health.

I hope this answers your question — and inspires you to try AlgaeCal, which significantly improved my bone density in only 10 months, so I can vouch for it personally, and this is why I am doing what I can to help get the word out about AlgaeCal. I know it works, Lara


Thanks for your response about New Chapter. However, my confusion now lies in the amount of calcium in the two tablets of AlgaeCal Plus. There are only 360 mg of calcium in the two tablets listed as “serving size”. Even taking 3 tablets only increases the calcium intake to 540 mg. This is not nearly enough to take in conjunction with the amount of suggested strontium. (We should take more calcium than strontium in order for both to be effective.) Please let me know what you suggest in order to take the AlgaeCal Plus to ingest a healthy amount of calcium.
Additionally I have been using Doctor’s Best Strontium. Do you have any information regarding this product?
I would really appreciate hearing from you before I place an order for the AlgaeCal Plus and possibly, their Strontium Boost.

Lara Pizzorno

Hi sml,
Yes, the label is confusing. Full day’s serving of AlgaeCal Plus is 4 capsules — 2 capsules twice daily. When I first started taking AlgaeCal, I didn’t realize this for several months. So, amount of calcium provided by AlgaeCal Plus is 720 mg/day, plus you need to look at your diet to see how much calcium you are typically getting from the foods you eat. Most people get somewhere around 400 mg/day or more of calcium from their normal diet (e.g., milk, yogurt, cheese, leafy greens, soymilks and yogurts, etc., also enriched with calcium — in Your Bones, I provide a full listing of the foods rich in calcium, how much is in a typical serving, so you can figure out what YOU are getting). I don’t know how much strontium is in Drs Best (am currently in Toronto airport with just a few minutes before my connecting flight to Washington DC, so no time to look), but most supplements providing strontium citrate (which is what you want — you do NOT want the patented drug form, strontium ranelate!) provide 680 mg of elemental strontium as this is the dosage shown in the research studies to be effective. AlgaeCal Plus provides more calcium than this amount of strontium and surely with your dietary intake of calcium, you will be getting quite a bit more than 680 mg. Re Drs Best strontium — if it is strontium citrate, it should be fine. I am not familiar with the quality control standards held by Drs Best — you might want to check with them to learn what tests are run to ensure their products are free of contaminants, etc.
Re K2 (MK-7) — I don’t know how much vitamin D3 YOU need to get your blood levels into optimal range (60-80 ng/mL). If you need the amount of vitamin D3 required by the “average” person (for whom 2,000 IU/day is often sufficient), then 100 mcg of K2 (MK-7) should be fine. If you need 5,000 to 10,000 IU of D3/day, then you will need more K2. D3 and K2 must be in balance. Vit D3 increases your body’s production of vit K dependent proteins, so you will make more of them and will need more K2 to activate them. For example, I personally need 10,000IU of D3/day to get my blood levels into good range, so I need at least 300 mcg of MK-7. I try to get around 400 mcg/day of MK-7 from supplements plus my diet. Hope this helps, Lara


One additional question (I just finished posting my prior questions to you.) Is there enough K2 in the AlgaeCal Plus or should I supplement (and if so by how much?)


Hello again Lara:
I take about 6000 iu’s of D3 daily and will be increasing to 7000 iu’s in order to get me blood level above 60 nG. (at 6,000 iu’s my levvel was at 55 nG.) Is there a certain brand that you would recommend for vitamin K2 in order to balance the level of D3? I will be getting about 100 mg of K2 (MK7) from my other supplements. Based on your previous response to me I should probably add to my K2 amount. What amount would you suggest? Is there a toxic level for K2 (MK7)?
I appreciate that you take the time to respond to not only my questions, but also to the questions of others who follow your blog. Your advise and expertise is very much apppreciated.

Lara Pizzorno

Hi sml,
If you take AlgaeCal Plus, the full daily dosage will be giving you 90 mcg of K2 (MK-7). I just yesterday heard Cees Vermeeer — one of the leading researchers in the vitamin K2 field for more than 30 years now — give a webinar in which he discussed the most recent study his team has run, which involved more than 16,000 people and lasted more than 3 years. They found 180 mcg was an effective dose, even for those whose initial levels of unOC were severely depressed. Since you are getting 100 mcg from your other supplements, if you just took the full dose of AlgaeCal Plus, you would be getting 190 mcg/day. If you are taking 7,000 IU vit D3, then this amount of MK-7 should be adequate. If you end up finding your vit D3 needs run even higher — to 10,000 IU/day — you could check out Life Extension’s vitamin K supplement, which is what I use for my additional K2 since I must take 10,000 IU/day of D3. The LEF supplement provides 100 mcg of MK-7. No toxicity has ever been shown for K2 (MK-7) at any dose used — even in studies in which subjects took more than 800 mcg/day. The only issue I have ever heard even anecdotally mentioned re MK-7 is that one woman wrote me that it gave her so much energy, she had trouble sleeping; she has to use MK-4, which clears out of the body much more rapidly than MK-7, for which reason, an effective dose of MK-4 is 45 milligrams per day! And you have to take this in divided doses of 15 mg / 3 times a day as MK-4 is cleared by almost everyone within 4-6 hours. This woman does better with MK-4. A couple of months ago I saw new research suggesting that some people (a VERY few of us, obviously including the woman who wrote me) may be able to get by with less K2 — these are persons with some rare SNPs that result in their keeping K2 around longer than the vast majority of us. I’ve written up all this research for inclusion in the 2nd edition of my book, Your Bones, which will be out in March 2013 — it’s very interesting! YOUR best solution is highly likely to be around 180 mcg of K2 as MK-7.


Re: Life Extension K2 – There are two available K2 products from them. The Advanced Super K contains all three of the Vitamin K (to total 2100 mcg of K activity) per tablet, the Low Dose K2 has 45 mcg of the MK7. I am leaning toward taking two of the Low Dose LE K2 rather than accumulate too much of the other K vitamins in my system. Once again I am taking 7000 D3 and am needing about another 100 mcg of MK7 (90 mcg is also OK). Which of the LE products do you recommend?
Again, thanks for all your prompt responses and your amazing insight!

Lara Pizzorno

Either product will be fine. The amounts of the other forms of vitamin K (K1 and MK-4) are so tiny, they will have little impact on activation of Gla-proteins. Actually, the K1 will have no impact on Gla protein activation — it will be used for clotting factors and also has anti-inflammatory effects (so good to help prevent excessive activation of osteoclasts, which is triggered by chronic inflammation). MK-4 requires 15 milligrams 3x daily for efficacy. What you really want is about another 100 mcg of MK-7 — so you could take 2 capsules of the Low Dose K2 formula or 1 capsule of the Advanced Super K. I’d check costs and go with whichever one is least expensive. I expect you are consuming plenty of leafy greens and other vegetables rich in K1, right?


Hi Lara,
Just wondering if you have seen elevated alkaline phosphatase while using strontium? My level is slightly high (113) but has gone up from 83 in February. I am a 2 yr breast cancer survivor and of course am worried about bone mets. I have been taking an aromatase inhibitor for 18 months and started taking strontium this past June after being diagnosed with early osteoporosis. I am 61 and feel great. My MD has ordered another ALP in one month but since I know strontium can build bone, I’m wondering if that could cause the elevated ALP. Thank you!

Lara Pizzorno

Hi Diane,
An increase in your alkaline phosphatase level is good news! Alkaline phosphatase is an enzyme involved in bone formation. At 113, you are well within normal range — which is 20 to 140 IU/L. Also, as you know, aromatase inhibitor drugs promote bone loss, so the fact that, despite taking them, your ALP has gone up suggests the strontium (hopefully strontium citrate! NOT ranelate) is helping to protect your bones.


Hi Lara:
Has any research been done to show the safety of using strontium citrate for years? How long is it safe to use at the full recommended dosage and at what dosage is it safe to use after reaching the “normal levels’?


Re; Robert Gouterman January 17, 2012 at 8:31 am [i.e second post above]
In Laura Pizzorno’s blog , she refers to the excretion of ranelic acid , and questions the non excreted portion. What is the excretion of strontium citrate?

What is the answer to Gouterman’s question…? It remains unanswered in response above!

Lara Pizzorno

Hi Antigone,
Both strontium and citrate are natural substances that are highly beneficial to and are utilized within the body — ideally, the majority of the strontium in strontium citrate supplements is absorbed into bone, increasing bone mass and strength. The citrate portion is both an alkalinizer (so helps prevent an acidic body pH, which promotes calcium withdrawal from bone / bone loss) and is also used in the Krebs cycle (a key part of the energy production cycle in our cells). Ranelic acid is a new to nature compound, synthesized in a lab by a pharmaceutical company so they could combine it with strontium and thus patent the result — the purpose of this is to make money, no other reason. Ranelic acid’s only claim to fame is that it is SUPPOSED to be inert. The fact that strontium ranelate may cause venous thromboembolism and DRESS syndrome (among other nasty effects) strongly suggests otherwise. Hope this answers your question, Lara


What is a suitable no calcium snack to have with the Strontium Citrate? I have been having it alone and away from the Algaecal. Thanks Mary


Hi Lara:
(I am resubmitting my questions hoping to get some answers regarding the length of time to take strontium.)
Has any research been done to show the safety of using strontium citrate for years? How long is it safe to use at the full recommended dosage and at what dosage is it safe to use after reaching the “normal levels’?

Lara Pizzorno

Dr. Wright and I both believe that once bone mineral density has been significantly improved using the dose shown in the research to be effective (680 mg elemental strontium/day) should be reduced to half this amount (340 mg elemental strontium/day)for long term bone health. Again, most important is that you take at least twice as much calcium as strontium. As I have explained both in Your Bones and here on AlgaeCal’s blog, strontium and calcium compete for absorption, and calcium will always win. Thus, you want to (1) consume more calcium (from diet and supplements) than strontium, (2) take these 2 minerals at different times of day to get the most bone health benefit from strontium citrate. Hope this helps.


Hi Lara,
I have joint and bone pain and have been using algaecal and strontium for about 3 months. I am concerned about the pain spreading to my knees as I can feel some pain at times there now. The pain occurs when I do something with my hands and arms. I have been on fosamax for years though not always regular.I have discontinued the alendronate since June 11 when I felt some pain in the hips when lying on my sides. It seems to have disapeared and I was hoping the algeacal is working. I have also used Prednisone for many years but was able to discontinue it July 30. The pains seem to have more or less coincided with the reduction in Prednisone.
However, the doctors seem to not be aware of any alternate to bisphosphates.
I have been scheduled to have a bone scan which is not the density scan but one where you are injected with a radioactive tracer and then after 3 hrs. or so a camera senses the radioactive accumulation in the bones for pictures. The doctor hopes it will give us a better idea of what is causing the pain.
How does the absorbtion of the tracer affect the bones and the osteoblast activity? Does it increase the activity of osteoclasts? I didn’t find anything on that in “Your Bones”. Do you think it is worth the risk or is it much of a risk for further bone deterioration? What kind of setback would it be to bone growth?
Thanks, John

Lara Pizzorno

Hi John,
First please accept my apologies for not responding sooner. I’ve been traveling — giving a series of Wellness Lectures on bone health up in Vancouver, BC, and am just catching up now on my emails. The bisphosphonates you were on could definitely be the cause of the pains you were experiencing. It is now well accepted that these drugs cause pain in susceptible individuals, and the pain may not go away for quite awhile after the drugs are discontinued. Also, I expect you are aware that Prednisone causes bone loss. Your doctor should certainly know about this — many studies over many years have shown this and the medical community is well aware of it. I very much hope your bone scan will give you a better idea of what is causing your pain. Any type of chronic inflammation will activate osteoclasts; thus, for healthy bones, you want to lessen chronic inflammation as much as possible, regardless of its cause. Once you have more insight into the cause of your pain, we can figure out ways to eliminate that restore your health and do not destroy your bones! I do not think the tracer will affect osteoblast activity. If you have not read Your Bones, I urge you to check out a copy from your library, which will definitely have it, and read through all the many contributing factors to bone loss that I discuss in the book. These factors affect men just as much as women (with the exception of menopause, of course, although men experience andropause about 10 years later, early 60s, and the drop in testosterone production affects men’s bones since some testosterone is converted by men into estrogen and is needed for bone). You want to identify which factors are impacting YOU and eliminate or at least ameliorate these, AND you want to take a look at your diet to see how much of the nutrients required for bone to build are being supplied and then both change your diet to deliver more of these when needed and also supplement to bring your intake of all the nutrients involved in building bone up to optimal levels. AlgaeCal Plus and Strontium Boost are a great start. You may need additional supplements to achieve optimal levels, and there is no way for me to know what YOU need. I wrote Your Bones to help you figure this out. You will need to keep a food diary for 3-5 days and then do some checking — all the info you need is in the book. You may also need to have a blood draw to check your levels of 25(OH)D — the circulating form of vitamin D. Optimal levels are 60-80 ng/mL. Please get back to me when you have done some looking into what YOU need, and I will do my best to answer any further questions you might have. Be well! Lara

Derek O’Brien

John’s age, PSA (and PC status), Testosterone and diabetic status need to be known. Also vit D3; supplementation to 10,000 units a day can help.

Some men have seriously low testosterone levels, and this could predispose them to PC as well as osteoporosis. See Morgantaler re testosterone and PC development.

If PC status is OK, and PSA is low, hefty supplementation using testosterone implant/depot injection or gel is advised.

Also vit K2, Super Ubiquinol. Vit B group. Vit A. Vit C, (Life Extension “2 per day” multi-vitamin/mineral formula is good way to do this). Copper, zinc, boron, manganese, chromium, vanadium, magnesium. And lots of hi-bio-available calcium, strontium citrate, fish oil.

Six months of the above will make a big difference in his quality of life, no matter how old he is.

John needs to be walking at least 30 minutes a day, 7 days a week.


Hi Lara,
l have severe osteoporosis and digestive problems, mainly acid reflux, so am quite underweight. Also, l have been taking proton pump inhibitors for some years now which l think has probably contributed to the osteo problems. l have had to come off the bisphosphonates which l think may well have started the reflux problem. l have tried Strontium Ranelate but had to stop because of the painful indigestion and nausea. Do you think l might be able to take the Strontium Citrate or would this have the same effect on my stomach.? l currently take AdCal D as a calcium / vitD supplement 1200 mg/800 iu per day but it is a carbonate and l am considering changing to AlgaeCal which l think might be better for me. l am trying hard to wean myself from the ppi’s and it is proving very difficult. They don’t help very much anyhow.
Would be most grateful for any suggestions you might have.

Lara Pizzorno

Hi Carol,
I have a VERY good suggestion for you — PLEASE read Why Stomach Acid is Good for You
Digestive problems are very frequently caused by insufficient production of stomach acid, not too much! And taking PPIs makes the situation much worse. If you are not producing stomach acid, you cannot digest your food, cannot release the nutrients in your food so they can be absorbed, cannot solubilize calcium )and other minerals) so you can absorb them. The PPI drugs are not helping b/c they are highly likely to be making your situation worse, and these drugs cause bone loss (b/c you cannot absorb calcium without stomach acid). In one of the blogs I’ve written that is posted here on AlgaeCal’s website, I discussed these (and many other drugs) that promote bone loss. I also cover this issue in Your Bones. I realize this may sound counterintuitive to you, but urge you to read the above book. You can fix this!


Hi Lara,
Thank you so much for your early reply regarding ppi’s. l will most definitely follow through on that link to the book you suggested. Meanwhile, would changing my source of calcium intake be of any use if l am not absorbing it fully.? l forgot to mention that l have also taken valium for many years. l am sure l have read in one of your blogs that this too can contribute to bone loss. There is not too much that l can do about that one as it would be too difficult to withdraw from. l suppose l have just got to concentrate on doing the best that l can. l have been told that my Vid D levels are good but not quoted the actual figures. It seems different countries have different parameters – sure l have mispelt that but l think you will understand. l live in the UK. l am currently being offered Forsteo as a first choice and then Denosumab. l really do not want to take Forsteo but am wondering if l really have a choice as my Dexa results are so bad. My spine is -4.5 and hip is – 3.1 approx. l have mislaid my paperwork with exact results . l have a lot of low backache radiating into my hips and right leg, also painful feet. An x ray some months back showed “wear and tear”. My doctor thinks that could be the osteo problem. On the plus side l am still able to walk about two miles each day and stay as active as possible being careful with lifting etc. l do some light weight exercises also. Your comment on whether or not a change of calcium would benefit me would be much appreciated and thank you so much for taking the time to help me. You are very kind.


Dear Lara,

Thank you so much for this blog. I have read everything from January 2012 to the present and you have given me a wealth of information as well as hope. I am 61, 5’2″, 115 lbs, with a very small frame. I had been taking Actonel for over 7 years. I took myself off of Actonel almost two years ago when there were reports of “atypical femur fractures” with bisphosphonates and because my last DEXA indicated that MY HIP DECREASED 2% with a T score of -2.1. A check of vitamin D and calcium excretion indicated everything was in good range. I had my uterus and ovaries removed when I was 54. I also had prophylactic bilateral subcutaneous mastectomies due to benign disease in my 30s. I have been taking a topical estrogen gel which I hope can help some to protect my bones….and which I believe is relatively safe for me since I am without breasts, uterus, or ovaries. I had made myself notes to research Vit K-2 and Strontium after hearing either Suzanne Somers, Dr. Mehmet Oz, or Dr. Richard Besser mention one or both on TV. It is disappointing that neither my primary care physician nor my gynecologist has mentioned Vitamin K-2 or Strontium. I am so glad I came across your blog in my Goggle search. After reading your blog, I am motivated to have a new DEXA done to see where I stand on T scores and then start the AlgaeCal Plus and Strontium Booster program. I thank you for providing your readers with excellent answers to their questions, some of which were questions I also wished to ask. In a related issue to bone, I had wanted to straighten my lower incisors with the Invisalign braces a while back…. before I was aware of my bone loss issue. Then I became aware of bisphosphonate related osteonecrosis of the jaw and I didn’t want to take the chance of being one of those few patients. If I can improve my bone density with the AlgaeCal and Strontium Booster, maybe one day my osteoblasts will do the job to help me have a more beautiful smile. Like I said, you have given me hope. Thank you and I will stay in touch as I am sure I will have questions.

Lara Pizzorno

Hi Elizabeth,
Thanks so much for letting me know you found the blog information helpful. In addition to utilizing AlgaeCal Plus and Strontium Boost, I suggest you (1) get your blood levels of vit D (25(OH)D checked to be sure you are getting enough, optimal range is 60-80 ng/mL, and (2) look into bio-identical hormone replacement of not just estrogen (bi-est) but also progesterone and DHEA. Very helpful cutting edge tests are now available to check all your hormones (and their metabolites), so you can see exactly where you are and whether you are producing protective or potentiallly cancer-promoting metabolites, and if the latter, you can rebalance using natural safe means. I’ve written articles about these tests on Longevity Medicine Review, which is free access, but is written for doctors, so a bit technical for normal folks. Here’s a link to this if you want to take a look:
For information written for the public, take a look at a book with a dreadful title but great information — Dr. Jonathan Wright, MD’s book, Stay Young & Sexy with BHRT.
Happy to try to answer any questions you might have.
Be well! Lara



Firstly sincere thanks and appreciation for the contents of this blog. The time, effort, and knowledge which you apply to answering questions is amazing. It is so helpful to have technical matters explained with such authority in understandable terms. If I might ask your comments on two issues which I have come across, I would be very grateful. I have your excellent book so I will not ask you to repeat anything from there. I would be interested to learn of any further research on Lactoferrin and its positive effects on bone building. Also, if used, would there be any conflict issues with strontium and its effect of bone building or in the same way as there are with strontium/calcium. It seems that the many benefits of lactoferrin are well known, but its effect on bone building are not so well documented.

Secondly I have recently found reference to Pulsed Signal Therapy which appears to be a recent development of older techniques. It seems that positive effects on bone building were only noticed as a complementary event to pain relief and healing. Again research seems to be quite limited but is apparently on-going and seems to be promising. and Any information which you possess would be very much appreciated.

Many Thanks

Lara Pizzorno

Hi John,
Thanks, delighted you have found the blogs and Your Bones helpful.
Re lactoferrin, it looks quite promising. The study to which you sent me a link is the only human study I could find, but recent papers indicate lactoferrin may be quite helpful. It’s not a mineral, so absorption should not be impacted by strontium (or calcium), also lactoferrin’s mechanisms of action are quite different from those of strontium/calcium. In sum, it should be fine to use lactoferrin along with strontium. Here are the two most recent papers I found most interesting and helpful:

Hou JM, Xue Y, Lin QM. Bovine lactoferrin improves bone mass and microstructure in ovariectomized rats via OPG/RANKL/RANK pathway.
Acta Pharmacol Sin. 2012 Oct;33(10):1277-84. doi: 10.1038/aps.2012.83. Epub 2012 Aug 20. PMID: 22902986

Cornish J, Naot D. Lactoferrin as an effector molecule in the skeleton. Biometals. 2010 Jun;23(3):425-30. Epub 2010 Mar 16. Review. PMID: 20232111

Re pulsed signal therapy — this also looks both safe and helpful. The link you sent me goes to a website basing their claims on research conducted no later than 1993, so I checked PubMed to see if more recent papers had been published (which one would assume they would be if this therapy was helpful). I found a number of recent papers. Here are a couple of the most recent:

Angle SR, Sena K, Sumner DR, Virdi AS. Osteogenic differentiation of rat bone marrow stromal cells by various intensities of low-intensity pulsed ultrasound.
Ultrasonics. 2011 Apr;51(3):281-8. Epub 2010 Sep 26. PMID: 20965537

Ferreri SL, Talish R, Trandafir T, Qin YX. Mitigation of bone loss with ultrasound induced dynamic mechanical signals in an OVX induced rat model of osteopenia.
Bone. 2011 May 1;48(5):1095-102. Epub 2011 Jan 15. PMID: 21241838

Schofer MD, Block JE, Aigner J, Schmelz A. Improved healing response in delayed unions of the tibia with low-intensity pulsed ultrasound: results of a randomized sham-controlled trial. BMC Musculoskelet Disord. 2010 Oct 8;11:229. PMID: 20932272

This last paper is of especial importance since it shows low intensity pulsed ultrasound therapy does not promote cancer — here is a quote from the conclusion of this paper:
“LIPUS stimulation on metastatic bone tumors induces differentiation of osteoblasts without proliferation of tumor cells. Our study suggests that LIPUS may be a new method of treatment without surgery for metastatic bone tumors.”
Sawai Y, Murata H, Koto K, Matsui T, Horie N, Ashihara E, Maekawa T, Fushiki S, Kubo T. Effects of low-intensity pulsed ultrasound on osteosarcoma and cancer cells.
Oncol Rep. 2012 Aug;28(2):481-6. doi: 10.3892/or.2012.1816. Epub 2012 May 17. PMID: 22614439

Hope this helps answer your really great questions, Lara


Ms. Pizzorno,
I have just been skimming through the above blogs and I may have missed it…how much of the Stronium Boost do you take daily? I have been taking the 3 capsules at bedtime (2230 mg) which is recommended on the bottle but I also take synthroid for hypothyroidism. I noticed a blog that mentioned the thyroid gland,also went back and read Your Bones which recommends 680 mg. Should I take only 1 capsule daily of the stronium boost instead the 3 capsules? I don’t want to do something that would cause other problems. I also take 4 capsules of the Algaecal Plus daily(lunch/dinner). I will have my blood work done at the end of November for thyroid, calcium, Vit D, and cholesterol. Thanks so much!

Lara Pizzorno

Hi Debbie,
Strontium citrate should not interfere with synthroid, no worries there. Re strontium dosage, what is now being recommended is to take the 680 mg dosage until bone density is improved, then to cut back to one-half or one-third of this dosage. So, how much strontium YOU need will depend on the results of your next DXA. Hope this helps, Lara


Thank you so much! I will change the dosage….1 capsule of stronium boost is 743 mg…that is still more than the 680 mg. Is that okay? When your bone density improves…how do you cut back to one-half or one-third if the pills are in capsule form? Again, thanks for your prompt response and help.

Lara Pizzorno

Hi Debbie — the info on the Strontium Boost label is confusing, I know, but what it says is that 3 capsules provide 680 mg of elemental strontium. The 2230 mg amount is the milligrams of strontium plus citrate. In other words, 3 capsules give you 1550 mg of citrate AND 680 mg of strontium. So, each capsule provides 226 mg of strontium.


Oh my…so sorry I didn’t read the fine print….it was right there! I appreciate your patience! Thanks for responding!!!

Lara Pizzorno

No worries — it took me months to figure this out. I started out taking just 1 capsule not because I wanted to take less than 680 mg of strontium but b/c I did not carefully read the label. As I am still osteopenic (though just barely so now), I continue to take the full 680 mg dose. My next DXA is due to be run May 2013 — I expect I will no longer be even barely osteopenic.. If so, I will drop down to 1 capsule then.


Hi Lara,
I have been on Alendronate for many years but stopped using it June 11. I had felt some tenderness on the side of my hips lying in bed.
I had a density scan that showed not much change in the last 2 years but my density is very low. Due to being on Prednisone for years, though I have been off it for 3 1/2 months now.v The doctor wants me to go back on Alendronate but I started using Strontium citrate since Aug. 30 instead. I also use AlgaeCal and Vitamin D and some C, eat vegetables and drink milk in the morning and at night. I have had blood tests that show normal levels of calcium and almost everything else.
Problem is that in the time since stopping Alendronate I have developed pain in my knees and heels sometimes.Also, in the area of the tailbone when I sit for a while. As well as in my hands and in arms when I work. My lower back also when I do anything too strenuous. My back and neck are still not bad. For years I would and do get a sore back when doing certain things like folding clothes for a long time or being bent over for quite a while. If my posture is good it is OK. Also, my hips don’t seem bad.
But now my front teeth feel sensitive too. Not painful but not from drinking hot or cold liquids. It is getting more uncomfortable.
My biggest concern is I don’t want to become crippled and unable to walk if this continues to worsen so I would like your thoughts, please. I am rather desperate so am even considering taking Alendronate again. I have your book and have studied it. It appears that the Strontium would decrease the risk of fracture in women and would it be the same for men as I assume? It sounds like the bisphosphonates would decrease the risk more. But at some point the consequences would be greater.
Are we sure Strontium Citrate has the same effect as the Strontium Ranelate in the studies?
But would it be better to just go with Alendronate since my density won’t increase for at least a year after being on it so long? I would really not wish to but I can’t afford to lose more bone. Or am I losing bone?
I also don’t see any side effect that would cause dental problems. Is that from bone loss in the jaws? I am aware of Osteoencrosis and had an x ray in the summer that showed some dental surgery I had 6 years ago had healed very nicely.
Sorry my letter is so disjointed but if you can find all my questions in it and comment, it would be greatly appreciated.

Lara Pizzorno

Hi John,
Both alendronate (Fosamax) and prednisone have contributed to your current problems. Fosamax, as you know if you have read the first edition of Your Bones, causes the retention of old brittle bone. I’ve written a lot more about Prednisone in the 2nd edition, which will be out in March 2013. Like all the other pseudo-gluccocorticoid drugs, prednisone kills osteocytes (which is what osteoblasts turn into after they begin secreting the bone matrix). Thus, the glucocorticoid patent medications cause a rapid weakening of bone architecture (within 6 months of initiating treatment) even at very low doses. In addition, these patent medicines deplete the body of vitamin D3, interfering with normal calcium metabolism and absorption. Pseudo-glucocorticoid “therapy” is the leading “iatrogenic” (a term that means “caused by a medical treatment”, in this case, patent medicine-induced) cause of osteoporosis. Several large case–control studies have confirmed strong associations between pseudo-glucocorticoids and greatly increased risk of fractures.
In sum, these drugs are not the best option for you.
Re strontium — it is the strontium in either strontium citrate or the patent medicine, strontium ranelate that is providing the benefit in bone. Citrate is also beneficial as it helps produce a more alkaline pH in the body — citrate helps prevent the low-grade metabolic acidosis – an overly acidic pH –that is caused by a diet too high in protein, is quite common in the U.S. and Canada, and causes bone loss. Ranelic acid, in contrast, is a new-to-nature hydra headed compound specifically created just so strontium could be patented (for anything to be patented, it must be “new to nature”). Strontium ranelate has been shown to greatly increase risk for venous thromboembolism and DRESS syndrome, plus a bunch of other nasty (but less likely to cause death) effects. I’ve posted a blog here on AlgaeCal discussing this if you would like more information. I’ve also added much more info re strontium to the 2nd ed of Your Bones.

I don’t know why you were taking prednisone, so can have no insight into what might be the fundamental cause(s) of your chronic inflammation and resulting bone loss. My best suggestion for you is to find a physician who is knowledgeable about promoting health rather than suppressing or attempting to merely control symptoms for a while with drugs. The Institute for Functional Medicine is the premier source of such highly educated, cutting edge doctors. The American Association of Naturopathic Physicians can also be helpful — this group is the AMA equivalent of naturopathic medicine. I urge you to get the medical care YOU need to determine WHY you are experiencing chronic inflammation and bone loss — then you can fix what’s off and regain your true health.

A few thoughts for things you might check into — do you eat cold water fish such as Alaskan salmon? These fish are rich in omega-3s, essential fats that are highly anti-inflammatory and are deficient in the standard American diet. How is your digestion? are you able to absorb the nutrients from the foods you eat? Are you getting any exercise? Also has anti-inflammatory benefits, and many more!


Hi Lara,
Thank you for your reply. I neglected to mention that I had taken Prednisone (along with Mycophenolate and shorter times with other immunosuppressants) for an autoimmune disease called Pemphigus Vulgaris. My immune system would produce antibodies against a certain component in my skin causing water blisters that don’t heal. I am now free of it finally but unfortunately have to deal with the effects of the meds.
I guess my big fear is that if continuing to take Strontium helps but only after I lose all the old brittle bone kept from using Alendronate for so long, then I may have virtually no bone with which to start the rebuilding process. Is this an accurate reasoning (Not that I have much of an option) ? I live in Alberta so wait times are long to see a doctor and more so to see a specialist. Makes it difficult to ask questions when they come up. I can’t get to see a specialist (Rheumatologist) till Jan. 15 but I could take a bone scan, (with radioactive tracer) as the doctor suggests, but would that be helpfull if bone loss is the cause of pain? How would you know if bisphosphonates are the cause of pain? Would a scan give a definite answer to what is causing pain or discomfort in my joints, heels, arms and hands. When at the doctors, I thought the scan was going to be a density scan so didn’t ask all these questions.
Again, thanks sincerely for taking the time and interest to answer my questions,

Lara Pizzorno

Hi John,
AlgaeCal has been reworking the blog and a number of emails sent to me are just now coming my way. So sorry for the delay in replying to you. The good news is bone remodeling is always and constantly a process of laying down new bone while old brittle bone is being removed, so you do not have to wait until the brittle bone whose removal was prevented by Alendronate to all be gone before your body starts building new, healthy bone.
Yes, bisphosphonates are known to cause the type of pain you have experienced. A scan is not going to identify the cause though. I suggest you read the 2nd edition of Your Bones — check not only the discussion of the MANY factors that cause bone loss but also the Labs Appendix — 30+ pages where I list numerous labs (and explain them) that can help you identify what is contributing to your bone loss — although in your case, I suspect the drugs you required for Pemphigus Vulgaris were a key factors. Now that you no longer need these drugs, supplying your bones with what they do require to rebuild should show good results within 6 months. Again, check Your Bones for the tests you will want to run to verify.
Hope this helps, Lara


Dear Lara:
Your articles and work are most interesting.I would appreciate your answering a few questions I have written below. Here’s the background:

I am a healthy, active 69 year old. I have been told I have a T score of -3.4 from a DEXA taken in early October and that my bone loss was 5.3% in L1 to L4 region and 14.3 %,since 2002. My mother fractured her hip at ages 88 and 93, I had a fracture in my tibia in 2001,my father and brother have osteoporosis, so genetics play a part. Based on my recent blood tests, I have enough calcium and my D3 has been increased from 100o mg to 2000 mg daily, I have some antibodies in my thyroid so I may have a mild form of sjugen’s disease (On rare occasions when I eat something that may have red dye or tomato in it, my salivary gland will swell up). – I also take fish oil with DHA and EPA and a 1000 mg of B12 and my diet is without processed foods and soda and full of vegetables, fruit, nuts, yogurt and a little protein from chicken and on occasion lamb. I am 5 ft 4 inches and weigh 113 pounds. I was doing resistance exercises and weight bearing exercises and walking, but now am waiting to determine what I can and cannot do.

My doctors are giving me a choice of actonel, forteo and prolio (sp.?)’s well as strontium ranelate. Because of the side effects , I do not wish to take them, but I am concerned about the risk of fractures. I have read many articles on this site as well as on public citizen and others. I hope you can answer the following questions:

1) With a -3.5 T score, is my risk of fracture as serious as I am being to told? 2)If I go on a regimen of one of the algaecal products what do you recommend and the dosage ?( I am very sensitive to medicines and usually tolerate lower dosages than generally given.) 3) How long does one have to wait to take a DEXA again,i.e. if I wish to monitor the results of a supplement and exercise, when should I take the DEXA again and when will I know if it is working? Are 6 month intervals too little?4) Any other actions I should take?

Your response would be most appreciated. Thanks. Yona

Lara Pizzorno

Hi Gail,
Your diet and exercise regimen sound good, although I would check how much protein you are regularly consuming as your description of what you eat suggests your protein intake may be a bit low.I am assuming your digestion is good since you did not mention this — if it is not, then you will not be absorbing LOTS of nutrients your bones need. If your digestion is not good, Please read, Why Stomach Acid is Good for You by Dr. Jonathan Wright and follow the protocol recommended in this book to restore healthful digestion and nutrient absorption.
In response to your questions — yes, you are at increased risk for fracture; however, if you have read Your Bones, you will understand why the drugs recommended are NOT your best option for rebuilding your bones. My blog here discussing strontium should explain why you do NOT want to be taking strontium ranelate. Also a blog I wrote here on AlgaeCal re bisphosphonates. In the first edition of Your Bones, I provide 30 pages worth or reasons why you do NOT want to be using a bisphosphonate (e.g actonel). In the 2nd edition of the book, which will be out in March 2013, I add to this and also discuss the research re the side effects of Prolia (denosumab– same basic mechanism of the bisphosphonates so provokes all their negative side effects, plus it prevents maturation of key immune cells [T and B cells], so even worse than the bisphosphonates!) and Forteo (teriparatide — artificially spikes parathyroid hormone levels–if you have Your Bones, read the section about why hyperparathyroidism is bad for your bones; also Forteo caused osteosarcoma [bone cancer] in ~45% of the rats given the drug in the preliminary studies. Not a risk I would be willing to take, especially when a number of recent studies have now shown that you can rebuild your bones safely via a healthful diet, exercise and supplements. Check out the COMB study, lead author Dr. Stephen Genuis– here is a link to the abstract on PubMed: )
If you decide to use AlgaeCal Plus and Strontium Boost, which you could certainly try for 6 months rather than going on the drugs, you should absolutely take the full dose recommended on the label for each of these products. You should also get your levels of vit D checked (25(OH)D is what the blood test will check, optimal levels are 60-80 ng/mL). You may need more vit D3 than AlgaeCal Plus provides if your levels are low. Also you may need more K2 (as MK-7) if you are taking more D3 since the two nutrients work in concert.
Please forgive me for being so brief here; I am working on another book (this one on curing childhood asthma) that is due in to the publisher in just a few months and am, frankly, swamped right now trying to get it done.
I very much hope this helps you, Lara


Dear Lara:

Thanks for your prompt and thoughtful response. I will check out the digestion issue.
Who can I ask about the optimal frequency of DEXA tests so I am properly monitoring my bone density? At this point every 2 years does not make sense. Thanks again and I intend to get a copy of your book, especially since Gary Null cites you and your book.
Happy Thanksgiving ! Gail

Lara Pizzorno

Hi Gail,
You’re so welcome! DXA (they are now using the acronym DXA instead of DEXA) scans should be run once yearly — it takes time for bone to rebuild, so running this scan sooner will not provide good information for you. You can, however, run another type of test that will show you whether you are continuing to lose bone every month until your results show you are no longer losing bone and are stable. Bone resorption (“medspeak” for bone breakdown) tests measure the amount of certain bone proteins in the urine or blood (serum) that have been released from bone as a result of osteoclast activity. There are currently three such tests available: NTx, CTX and Dpd. The current research indicates that the serum CTX is the most reliable of the three, but the NTx is also good and is used frequently. Dpd testing is less used nowadays.
Happy Thanksgiving to you, too. I’m taking off a good part of today to be in the kitchen cooking pumpkins to make soup and custards, and making rice stuffing (we are gluten-free folks) to fill a kamboucha squash that will be our “centerpiece” this year. (We also do not eat meats, just fish, so it’s a turkey free zone around here as well, but I will fix LOTS of other things tomorrow morning as well — a Brussels sprouts souffle that no one believes contains Brussels sprouts :-), fresh cranberry salad, green beans and potatoes, mashed sweet potatoes and yams. I love this holiday! SO MUCH to be grateful for this year, as always, Lara



A delayed many thanks for your information on Lactoferrin and Pulsed Signal Therapy. There is so much information available from so many sources and this can, at times, be totally confusing and daunting, but the knowlegable and authoritative analysis which you provide in this blog to all your correspondents is invaluable and very much appreciated. May I ask one brief question regarding strontium/calcium conflict. You mention in an earlier reply that your own regime includes strontium at lunchtime, but if lunch has a high calcium content then you delay the strontium till later with a non-dairy snack. I presume that taking strontium with some other food rather than on an empty stomach is preferable for absorbability, but I wonder if this food must be as nearly as possible totally calcium free. If for example there is a 20mg calcium availability in the food, does this directly reduce the availability of the strontium by 20 mg, or is the relationship not so directly measurable. Sorry for such an unscientific question. Again very many thanks. John

Lara Pizzorno

Thanks for your kind words, John.
Yes, lots of conflicting info out there. When in doubt, always ask for PubMed references to back up what is said. If published peeer-reviewed medical research cannot be provided, then don’t trust what is claimed.
Re the strontium/calcium issue: these two minerals compete for absorption, and calcium will always win, so that’s why it’s recommended that strontium supplements be taken apart from either foods or other supplements containing significant amounts of calcium. In general, it’s best to take your supplements with a meal because when we eat, our stomachs produce hydrochloric acid (HCL), which enables us to digest our food and free up nutrients for absorption. In the case of minerals, HCL is required to solubilze minerals (put them into absorbable form).
As we age, however, many of us no longer produce adequate amounts of hydrochloric acid, so we are unable to digest our food well and get symptoms of indigestion, for which we then are told to take acid-suppresant drugs, which just worsens the problem — if your digestion is not in very good shape, I strongly suggest you read a book by Dr. Jonathan Wright, MD, entitled “Why Stomach Acid is Good for You.” You can supplement with HCL if needed.
If you are taking a supplement providing 680 mg of elemental strontium and consume some food with a wee bit — e.g., 20 mg — of calcium, no worries! This is not going to be an issue. I don’t know if you will not absorb precisely 20 mg of strontium if you consume 20 mg of calcium, but I am certain that –if you are producing sufficient hydrochloric acid, you will absorb most of the strontium — and that’s what counts for the health of your bones.


Hi Lara
I would very much appreciate your thoughts on a question I have. I have been on Fosamax for about 10 years because I have been on Prednisone for longer than that. I used to take calcium and vitamin D as well. However, I read your book and see that one study shows no BMD increase after a year on Strontium for those that were on bisphosphonates for 10 years or more.
So, does the body first get rid of all the old brittle bone that was kept by the bisphoshonate (in my case Alendronate), before new bone can be added or built? I would think that would be a lot of bone to lose. I have been off the Alendronate for over 5 months and takeing Strontium and AlgaeCal plus additional Vitamin D for the last 3 months. I look forward to hearing from you,

Lara Pizzorno

Hi John, I wish I could give you a precise answer regarding how long YOUR body will take to begin building new healthy bone, but all I can share with you is that in the research I have seen, it took some women much longer than others. Similarly, some women suffered fractures caused by bisphosphonates much sooner than others.
Since the bisphosphonates poison osteoclasts, the whole normal remodeling system gets shut down. It takes the body awhile to restore normal osteoclast function, and to remove the brittle old bone, then it takes more time to lay down the new bone. The cells in a region of the bone surface that are responsible for bone remodeling are called the “basic multicellular unit” (BMU), and when the time it takes for bone to remodel is dicussed in medical literature, it is the average lifespan of the BMU that is being referred to as the remodeling period. Remodeling is divided into 3 phases. On average, when a human’s system is functioning normally, it takes about 2 weeks for osteoclasts to actively resorb old damaged bone, 2 more weeks for them to completely shut down while osteoblasts are signalled and readied to start rebuidling new bone, and then 13 weeks for the new bone to be made. In real people — as we must always keep in mind, each of us is unique — each remodeling period can range from 3 to 6 months. Your body expects to replace about 10% of your skeleton annually. The good news is that, given the necessary nutrient support from both your diet and supplements along with weight bearing exercise — and of course, minimizing as many of the things discussed in Your Bones that promote bone loss as you can — your bones WILL begin to rebuild. You should get good feedback on how your bone rebuilding is progressing when you can next run a DXA — these tests are typically run annually since it takes this long for sufficient bone rebuilding to show up on the x-rays.


Hi Lara –

Could you comment on the possibility that strontium citrate can promote hair loss? I’ve seen this mentioned in comments on several websites.

Thank you

Lara Pizzorno

Hi Ann,
I have not seen this in any of the peer-reviewed published medical research, and I have now looked at all the major papers on strontium published in the last 100 years. I suggest you ask the folks making these claims for references in the medical journals in which research has been published confirming them, and if they cannot supply you with any, do not give them any credence. And this applies to ANYTHING you see on the web. Ridiculous rumors spread like wild fire, and I all too often hear from people frightened by the latest rumor scare tactics. Rely on Science, not rumor. If strontium promoted hair loss, don’t you think it would have been noted in the last 100 years in the many thousands of subjects taking strontium in numerous clinical trials?


Hi Lara,
My name is Lorraine I just turned 61 yesterday. I have osteoporosis. I was tested going on 3 years ago now. I don’t know those results other then I have moderate to severe osteo in my spine and hips, they prescribed Alendronate. I didn’t educate myself and just took it. Since this we retired moved across the state. I took the Alendronate for a year and a half and decided to stop after hearing bad things about it, but I never took any other precaution, thought maybe I would be better. I ate ok I guess and walked some but not a regular routine. Didn’t really think about it just knew I had osteo. Finally found a family doctor here, and had my second DEXA I actually saw the results and got a copy this time. My L-2 is -2.7, L-1-L-4 is -.2.4 Dual Femur Troch Left is-3.9 Dual Femur Total Mean is -3.3. This family doctor wanted me to use Fertgo at first and now recommends Prolia and suggested supplement strontium, that’s where you come in. I looked up Strontium and found you and ordered your book. I am excited about your book but some people say I should do what the doctor says. I’m really scared and quite confused. I did change my diet a lot, a lot of fruit and veggies etc. I have been taking a multi-vitamin women over 50 one a day, 600mg calcium w/ D twice a day, gummy vitamin D-3, plus bayer low dose aspirin. I’ve been walking at least twice a day and just added 1 1/2 lb. weights around my ankles. I’ve always avoided the sun because of wrinkling and now that’s what I look for each morning (we live in Florida). I forgot to mention last December 16th fell not because of osteo because one too many glasses of wine and high heels on. I broke my right clavical and got a huge knot on my right side of my head. I had to have surgery; I have a titanium plate on my shoulder. I never broke anything else I was extremely lucky but don’t understand how anything else didn’t brake, not that I wanted it to of course. I don’t drink now. That’s a contributing factor and I’m learning this the hard way. I guess this is stupid but I didn’t know that what you drank or ate had so much impact on your bones; I thought they were a hard and held you up. Also my vitamin D and calcium are good and my thyroid is fine, I’m basically in good health. I weigh 106 and 42 years ago when I got married I weighed 110. I guess now that is nothing to be proud of. Except for the times I was pregnant I’ve always been thin. I asked the doctor why this is happening to me she said I’m just prone to it. I’m so confused of what to do. Do I still take my one a day vitamins? My calcium is from Wal-Mart is that brand good enough and do I still take that? How about the gummy D-3? Is the strontium citrate and Algae cal correct, sometimes when people write and just say strontium or strontium boost or algae cal plus I get confused. Do you only get these on line? Is their a special brand that is correct to get? The doctor said my osteo is too advanced to try taking care of it natural and with supplements. I brought your book to my visit to the doctor she wouldn’t even acknowledge it. She seemed to be annoyed with me when I didn’t want the shot; initially I thought I was going there to find out about my vitamin D results, that blood test was taken after my DEXA scan since it was so bad. I mentioned being scared about your jaw falling off and she said she was more worried about my spine collapsing. I hope there’s hope. I want to live and with no fractures. Thank You for your knowledge and the time you take to help.

Lara Pizzorno

Hi Lorraine,
Sorry for not getting back to you sooner. Yes, I have been overwhelmed of late with writing deadlines and still am!
You CAN restore the health of your bones — and the program outlined in Your Bones is the way to do so. None of the drugs available for osteoporosis do more than retain brittle old bone, and they all come with a plethora of very nasty side effects — plus, you can only use these drugs for a few years — after which you are left with brittle bones and must then deal with the causes of why your bones are not remodeling properly. My best recommendation for you is to find a doctor who will listen to you and will be willing to help you restore the health of your bones (not just write out a prescription for a drug with many side effects that is not going to do more for you than cause you to retain brittle old bone). I don’t know where you are in FLA, but you can check with the Institute for Functional Medicine
(here is a link to their website: )
to see if you can find someone in your area who is well educated in the use of integrative curative medicine. You should also use Your Bones to check to see if you are getting all the nutrients required for bone health in amounts YOU need — you will need to look at your diet and your supplements to see how much you are getting. Also check all the factors that compromise bone — which are things YOU are exposed to. How is your digestion? Are you able to absorb the nutrients in your food well? MANY MANY questions here. PLEASE read the book and think about whether each section applies to you. Then write me back, and I will do what I can to provide you with useful information. BUT as I wrote initially, your best move is to find a physician who is knowledgeable about integrative medicine and who can help you through this process. PLEASE check out IFM. I KNOW you can restore the health of your bones – don’t let your doctor dissuade you from doing the very best for yourself.

Juan Filonenko

Hi Lara
I have osteosporosis and been takind Fosamax for 5 years .I am 61 years old and l decided to take the natural approch. My Lumber spine t score of 1.90 and z 169. Left
Femur t score of3.36 and z 1.48. The only concern l have if ALGAE CAL and STANTIUM been approved by the Medical Board Association in USA and CANADA For the safe treatment for osteosporosis.
Also l reserch same article about ALGAE CAL that contain certin levels of LEAD. That concern me. Could you please advise me re the above matter and any other scientific data. Regards Juan


Hi Lara,
I know your busy, I wrote on Dec 3rd and haven’t heard from you. Wondering if I did something wrong sending the letter or you haven’t received it. I’ve become more depressed worring about this. I just typed in comment and submited it, is their more than that to do? If so I’m not seeing it. Please let me know I can resend it. I am anxious to hear from you. Thank you so much.


Hello Lara: Just found your web site -really great reading. I had a Prolia injection in February 2012 and I have been in so much pain. I didn’t get the 2nd injection because of the side effects. My Dr. says it can’t be the Prolia but he wouldnn’t give me the 2nd injection he also says it should be out of my body by now. I have been on the Prolia comment site and it seems that I am not the only one with problems. The pain just won’t go away,do you have any suggestions. Some days I can hardly walk and my wrists and hands are also so sore. I am on Strontium Citrate 341 mg. Do you believe that Prolia causes so many side effects. Waiting for your response. Thanks Irene

Lara Pizzorno

Hi Irene,
I’m traveling, and internet service is VERY slow, so I am hoping my reponse gets back to you. Yes, I am certain that Prolia causes all the side effects seen with the bisphosphonates (e.g., Fosamax) plus quite a few more. Included in this very long list of adverse effects is the kind of joint pain you are experiencing, also muscle pain. I summarized the adverse effects of Prolia (denosumab) in another blog posted on AlgaeCal’s website. Normally, I would provide you with a link to this blog, but as I said, internet service here in the Cayman Islands is so slow that my computer will time out before I can get it for you. If you look at the list of the other blogs I have written that are posted on AlgaeCal’s website, however, you will see it; it’s entitled “Denosumab (aka Prolia, Xgeva) – Even Worse than the Bisphosphonates?” I also wrote about denosumab in detail for the 2nd edition of Your Bones, which will be out in March 2013. This is a very scary drug! I am so glad you are no longer taking it!
What may be happening is that denosumab is causing harm to the cartilage in your joints since cartilage is bone-associated tissue that requires normal remodeling and denosumab prevents normal bone remodeling; denosumab also interferes with the development of key immune system cells [T and B cells].
If denosumab is interfering with your body’s production of normal cartilage or your immune system’s ability to clear out inflammatory products, then using glucosamine may be helpful to you. Glucosmaine sulfate has been shown in the research to be helpful for joint health. I would recommend another form of glucosamine called N-acetyl D-glucosamine (sold under the trade name of Ultimate Glucosamine — FYI I have NO financial relationship with the company that produces this supplement and am not paid anything to recommend it! I use Ultimate Glucosamine myself to promote the health of my joints as I am now 64 and had begun to develop arthritis in one of my hands, which went away after 6 months of using Ultimate Glucosamine; my joints are all in great shape now, and it has been more than 3 years since I had any pain in them. I take Ultimate Glucosamine daily. N-acetyl D-glucosamine is the form in which glucosamine is utilized by our joints, so if you take glucosamine sulfate, your body will need to convert it to N-acetyl D-glucosamine before it is utilized to repair joint tissue.) If you try this, give it at least 3 months time to see if it will be helpful. It takes time for cartilage to repair.
You should also ensure your diet is optimal — I wrote at length in Your Bones (1st edition as well) about what constitutes an anti-inflammatory diet. Very basically, it’s free of processed refined sugar and chemical laden foods. And is composed of lots of (always organic if possible) vegetables, legumes, whole grains (you might avoid wheat and other gluten containing grains for awhile as these cause inflammation in some people), dairy (if not allergic to cow’s milk) omega-3 rich fish and eggs, and small amounts of pasture-raised meats, and fresh fruits (berries especially helpful as rich in antioxidants).
I very much hope this helps. Do let me know how you are doing. Be patient with yourself — your body is doing it’s best to heal. Just do all you can to support the process.


Hi Lara, I have read your book ‘Your Bones’ and appreciate all the information. Thank you for taking the time to answer all the bloggers above. I was diagnosed with severe osteoporosis 4 years ago when I turned 50. It appears that my osteoporosis is hereditary. My endocrinologist prescribed alendronate which I took for 3.5 years until we found that it was no longer effective. My doctor wanted me to begin using Forteo but after I read about the side effects I decided to look for alternatives and found your book. Now I am not taking any prescribed medicine and have started to take Strontium (for 3 months now) and the rest of the vitamins that you recommend. I am a vegetarian. I have some doubts and questions. What is the best calcium? What is the best multivitamin (now I take Centrum). Which Strontium do you recommend? Do you know of any reason why I should not take Doctors Best Strontium. I am taking 600 mg of Citracal and 500 mg that is included with Centrum (calcium carbonate). The rest of my calcium I get with my food. I am careful not to take the strontium and the calcium at the same time. I take 2000 IU of Vitamin D and 300 mcg K2 and 1500 Vit C and 500 of Magnesium Oxide. I am very disciplined with my diet eating a lot of fruits and vegetables. I drink soy milk and eat tofu products. But lately I have learned that spinach, tofu, nuts as well as other foods have oxalates which are said to interrupt calcium absorbtion in the bones. What comments occur to you regarding oxalates?
Could you recommend a multivitamin that contains the best mix of vitamins for someone with osteoporosis? Also, you suggest Ester-C in your book. Do you still feel that it is the best form of vitamin C? In your book you mention MCHC as a form of calcium. Is it better than the algae based calciums?
As I said, I took alendronate for 3.5 years. I have a lot of pain at times (most days and nights) in my back, neck and shoulder – especially on the left side. Do you think that could be related to the treatment? I have heard that it could go away as time goes on after one stops taking alendronate.
As I have investigated health issues I have become aware of the pH balance of the blood and the foods we eat. Do you think pH affects or blocks bone formation?
I really appreciate that you take time to read and respond. As you know there are many people like me struggling to get a handle on theses issues.

Lara Pizzorno

Hello Esther,
You are one of the courageous ones — not willing (and too intelligent) to just take a patent medicine that has been shown to, at best, only keep old brittle bone around, and at worst, to cause the bone fractures it is supposed to prevent. Doing what I can to provide you with some useful information is the least I can contribute! You asked many questions, and I cannot write another book here but will try to respond at least briefly to each of them.
If you read Your Bones you will know that I will be the first in all the generations of my family I know about to NOT die early from osteoporosis. It runs in my family as well — and why is it “hereditary” for me? My vitamin D receptors are slightly malformed, so I need way more vitamin D than the “average” person. When I get sufficient vitamin D to get my blood levels up into optimal range (60-80 ng/mL)– and supply my bones with all the other nutrients they need to remodel healthfully — then my “hereditary” disease goes away. I don’t know what the causes are of your “hereditary” disease, but I am certain they are just as fixable. You may also need more vitamin D than most folks or have an increased need for some other nutrient or be more susceptible to one of the many factors that I discuss in Your Bones which, if not minimized, can cause excessive bone loss. You need to read through the book carefully and think about all the issues discussed and ensure that YOU are getting what YOU need of all the nutrients required for bone health, and you are NOT exposing your bones to things that are potentially harmful, e.g., a diet that moves your body’s pH into a low grade metabolic acidosis range.
In response to your question, absolutely, pH affects bone. Too acidic a pH will result in your body removing calcium from your bones to make your system more alkaline. What causes an acidic pH– the standard American diet, too high in meat and animal products and refined grains and sugars and chemicals and way too low in the plant foods, particularly the mineral rich green leafy vegetables, that promote an alkaline pH and supply the minerals required for bone health. I cannot discuss all the specifics of a bone-bilding diet here, but if you follow the dietary recommmendations in Your Bones, you are unlikely to have an acidic pH. You can also check the non-profit website, World’s Healthiest Foods ( for information about pH and what types of healthful foods you can eat to prevent its being too acidic.
You need to have your blood levels of vitamin D (25[OH]D) checked to see if the 2,000 iu you are taking is enough for YOUR needs. Most of the patients we have evaluted need at least 5,000 iu/day, many need 7,500 iu or even 10,000 iu/day (as I do) to get their blood levels of vitamin D into good range.
Re vitamin K2, what form are you taking? if MK-7 then 300 mcg is likely to be plenty; if MK-4 then 300 mcg is nowhere near enough; you need 15 milligrams 3 times each day for a total of 45 milligrams/day if using MK-4.
Re strontium, if Dr’s Best is giving you strontium citrate at a daily dose of 680 mg of elemental strontium, then it should be fine. You might also check with Dr’s Best to ask about their quality control procedures and standards — what do they do to ensure their product is pure and free of potentiallly harmful contaminants?
For calcium supplements, I use AlgaeCal Plus. I discovered AlgaeCal after I wrote the 1st edition of Your Bones (the 2nd ed will be out in March 2013 and includes information about AlgaeCal). After reading the research published in peer-reviewed medical journals using AlgaeCal (which I believe has also been summarized somewhere on their website and which I discuss in the 2nd ed of Your Bones), I wanted to try it; my personal results (I ran my next DXA after using it for just 8 months) were so outstanding, so much improved that I am barely osteopenic now; I will continue to rely on this form of marine-algae-derived calcium. I believe it is more effective in building bone because you are not just getting calcium, but calcium in the matrix of all the trace minerals the sea algae used to build its bony structure. We now know — and continue to learn more about — the importance of numerous trace minerals for healthy bone remodeling. MCHC has also been shown in research to be helpful; it did not have nearly as beneficial an effect on me as AlgaeCal. As you know from reading Your Bones, calcium carbonate is not well absorbed and is the least helpful. If you are using this form of calcium, you must be sure to take it with meals to be able to absorb some of it.
Ester-C is an excellent form of vitamin C; plain old ascorbic acid is much less expensive and will also help. Eating foods rich in vitamin C (whole fruits, not juice since it delivers too much sugar too quickly) is highly recommended!
Lastly, for a multiple vitamin — I use BioFoundation-G, a cutting edge multiple vitamin, mineral and nutraceutical supplement designed by my husband, Dr. Joe Pizzorno, for BioClinic Naturals. This contains everything I need except for additional calcium, vitamin K and vitamin D, so I also take AlgaeCal Plus, a Life Extension vitamin K supplement, and Carlson’s vitamin D3. If we do not eat salmon or other omega-3 rich fish at least 3 times each week, I take a DHA/EPA supplement. And I take a probiotic supplement a couple of times a week unless I am eating lots of yogurt. Re BioFoundatio-G,, Joe was paid to DESIGN this formula; he is NOT paid anything more if more people buy it. I want to be very clear about this. We make NO more money whether you decide to try this supplement (or any of the other BioClinic Naturals supplements, which he also designs) or not. I think Life Extension also has a good multiple, although not as good as BF-G. But for YOUR bones, you will need to use the book (Your Bones) to figure out what YOUR diet is providing you and what YOU need and then choose the supplements that are optimal for YOU. This will take a bit of time and effort as you will need to keep a food diary for a few days and then use it along with the book to see what you are getting from your diet, then look at how much is optimal for bone health (also spelled out in the book) and supplement to make up the difference accordingly – but I promise you, doing this will be well worth your time!
In the 2nd edition of Your Bones, I have added a summary listing of all the nutrients I discuss in the book and the range in amount needed — but you will still need to optimize this information for YOU, and this is something no one can do better than YOU. You know yourself best, what you eat, whether you digest your food well, how much weight bearing exercise you get, what your daily lifestyle is like, what things you react negatively to (e.g., gluten, chemical sensitivities, etc), and so what YOU need to focus on to optimize your health.
Re your question about oxalates in spinach, tofu, nuts, etc. — you can get lots of detailed information about this on World’s Healthiest Foods. Bottom line–yes, oxalates are present in MANY foods, but no they are not going to cause a problem for your bones.
Yes, the pain you are experiencing could be related to alendronate — such side effects are well known to be caused by the bisphosphonates. The pain will almost certainly go away, but it may take some time, be patient and do all the other positive things you can to promote your overall health and that of your bones that I discuss in the book — my apologies for repeatedly telling you to read through it applying each section to yourself over and over again, but you do have a copy, and I cannot repeat everything here.
I very much hope this helps. Please feel free to write me again when you have more questions. And hang in there — your “hereditary” bone disease is definitely not due to a lack of a bisphosphonate or other patent medicine such as denosumab or teriparatide. You are either not getting enough of something your bones require or you are getting too much of something that is promoting inflammation and harming them. The trick is figuring out what is happening for YOU. Then you can fix it, and your bones will automatically fix themselves. I wrote Your Bones to help you do this.

Veneta Raymer

Hi Lara,
I just finished reading your article “The Truth about Strontium Supplements, Side Effects, DEXA Results, Efficacy and More,” as well as the abundance of information you graciously have provided to those seeking help and answers. I, too, am in need of your valuable advice for my sister and myself. I have ordered Your Bones from Amazon, but have specific questions regarding my 79 year old sister who has been diagnosed with polymyalgia rheumatica and also has osteoporosis. Her doctor has her on prednisone (currently reduced to 19 mg; previously 30 mg). She reduced it because my sister recently had a compressed fracture in her upper back. The prednisone does not seem to have much effect (even at 30 mg) in reducing the inflammation. She was biopsied for temporal arteritis and was negative, but was told that polymyalgia can advance to arteritis stage at any time. Her condition seems to be like a cycle: She cannot take a high dosage of prednisone (even low dosages contribute to osteoporosis) to impact the inflammation because it aggravates the osteoporosis, and from my research, inflammation contributes to osteoporosis as well. In the past, she has taken Fosamax for a number of years, but has not for over 5 years. She is basically a vegetarian but eats dairy and some fish. I have done most of my reserch at the Life Extension website. From Life Extension, she takes Bone Strength Formula with Koact , which has Calcium (from 3000 mg KoAct® Calcium Collagen Chelate and calcium fructoborate) at 300 mg which also contains vit D3 at 1,000 mg; magnesium 100 mg; silica 5 mg; dried plum 100 mg; boron 3mg. She also takes 500 mg of magnesium; 1200 mg of Calcium Citrate with 600 mg of Vit D3; Life Extension’s Vitamin D&K with Sea-Iodine; SAM-e 400 mg; Super Omega -3; resveratrol 500 mg; milk thistle. For the inflammation, she is taking N-acetyl-L-Cysteine 600 mg. For a number of years, she has taken Dr. Julian Whittaker’s multi-vitamin package. I have been reading about curcumin and how effective it is for reducing inflammation. However, my sister also has gallstones and one of the precautions is not to take curcumin if you have gallstones. Operating on the belief that curcumin truly is effective on reducing inflammation, I was trying to find something to dissolve the gallstones (Life Extension recommended lecithin which she is taking but last month she still had gallstones), so she could take curcumin and get the inflammation under control so she could get off the prednisone, which is severely worsening the osteoporosis. Her doctor now wants to put her in the hospital and give her an injection of a high dosage of a steroid to bring down inflammation and then an injuection of the new drug Prolia for the osteoporosis. What is your opinion? I recently learned about strontium but was confused about citrate and ranlate. Thanks to your blog and articles, I now understand the difference and how she should take the citrate version. Do you think she would benefit faster from the AlgaeCal form of calcium than what she is now taking? Also, her doctor says she needs at least 1,200 mg of calcium. If she switches to the AlgaeCal, should she be taking more as only 2 pills of the AlgaeCal Plus has 360 mg. She has only been on her current regimen for about 6 months. For years, a doctor (whom she no longer sees) had her on OsteoCal which seems to have done little to nothing. Also, I would like to get her started on the strontium citrate but am wondering if she should take the strontium and also the Prolia. Any advice you can give me is much appreciated. Thank you.

Veneta Raymer

Hi Lara,
I just finished reading your article “The Truth about Strontium Supplements, Side Effects, DEXA Results, Efficacy and More,” as well as the abundance of information you graciously have provided to those seeking help and answers. I, too, am in need of your valuable advice for my sister and myself. I have ordered Your Bones from Amazon, but have specific questions regarding my 79 year old sister who has been diagnosed with polymyalgia rheumatica and also has osteoporosis. Her doctor has her on prednisone (currently reduced to 19 mg; previously 30 mg). She reduced it because my sister recently had a compressed fracture in her upper back. The prednisone does not seem to have much effect (even at 30 mg) in reducing the inflammation. She was biopsied for temporal arteritis and was negative, but was told that polymyalgia can advance to arteritis stage at any time. Her condition seems to be like a cycle: She cannot take a high dosage of prednisone (even low dosages contribute to osteoporosis) to impact the inflammation because it aggravates the osteoporosis, and from my research, inflammation contributes to osteoporosis as well. In the past, she has taken Fosamax for a number of years, but has not for over 5 years. She is basically a vegetarian but eats dairy and some fish. I have done most of my reserch at the Life Extension website. From Life Extension, she takes Bone Strength Formula with Koact , which has Calcium (from 3000 mg KoAct® Calcium Collagen Chelate and calcium fructoborate) at 300 mg which also contains vit D3 at 1,000 mg; magnesium 100 mg; silica 5 mg; dried plum 100 mg; boron 3mg. She also takes 500 mg of magnesium; 1200 mg of Calcium Citrate with 600 mg of Vit D3; Life Extension’s Vitamin D&K with Sea-Iodine; SAM-e 400 mg; Super Omega -3; resveratrol 500 mg; milk thistle. For the inflammation, she is taking N-acetyl-L-Cysteine 600 mg. For a number of years, she has taken Dr. Julian Whittaker’s multi-vitamin package. I have been reading about curcumin and how effective it is for reducing inflammation. However, my sister also has gallstones and one of the precautions is not to take curcumin if you have gallstones. Operating on the belief that curcumin truly is effective on reducing inflammation, I was trying to find something to dissolve the gallstones (Life Extension recommended lecithin which she is taking but last month she still had gallstones), so she could take curcumin and get the inflammation under control so she could get off the prednisone, which is severely worsening the osteoporosis. Her doctor now wants to put her in the hospital and give her an injection of a high dosage of a steroid to bring down inflammation and then an injuection of the new drug Prolia for the osteoporosis. What is your opinion? I recently learned about strontium but was confused about citrate and ranlate. Thanks to your blog and articles, I now understand the difference and how she should take the citrate version. Do you think she would benefit faster from the AlgaeCal form of calcium than what she is now taking? Also, her doctor says she needs at least 1,200 mg of calcium. If she switches to the AlgaeCal, should she be taking more as only 2 pills of the AlgaeCal Plus has 360 mg. She has only been on her current regimen for about 6 months. For years, a doctor (whom she no longer sees) had her on OsteoCal which seems to have done little to nothing. Also, I would like to get her started on the strontium citrate but am wondering if she should take the strontium and also the Prolia. Any advice you can give me is much appreciated. Thank you.
Veneta Raymer

Lara Pizzorno

Hi Veneta,
Yes, you are correct — prednisone, even at low doses, causes significant & rapid bone loss.(Please see my blog on the topic of drugs that cause osteoporosis here on AlgaeCal’s website; also I’ve written quite a bit more about this in the 2nd edition of Your Bones, which will be out in March 2013.) And inflammation, regardless of its cause, promotes the activation and activity of osteoclasts, causing bone loss. What is needed is to figure out what is the CAUSE of your sister’s inflammation and to eliminate the cause, not simply take a drug (that also causes bone loss) to attempt to suppress the symptom. Based on the peer-reviewed medical research documenting the many adverse effects of Prolia (I have also written about this in another blog here on AlgaeCal’s website), I would not recommend Prolia. The potential for harm from this drug is even worse that that from the bisphosphonates, and it also cannot be taken for more than a few years.
The supplements she is taking are helpful; however, she may need a lot more than 1,000 IU (not mg) of vitamin D3 – the only way to know is to run the blood test to check her levels of 25(OH)D — the form in which vitamin D circulates in the bloodstream. Optimal levels are 60-80 ng/mL. She may also need more K2 (as MK-7); typical doses for this are 100 mcg but recent studies indicate 190 mcg or even more are more effective. Re the form of calcium you are using, I would recommend AlgaeCal as a better choice for several reasons: (1) peer reviewed in vitro and human studies prove it is more effective at stimulating bone growth (2) it delivers calcium in the matrix of all the trace minerals the sea algae utilizes to create its bony structure, and we now know that a wide variety of trace minerals play important roles in bone, (3) my personal experience using AlgaeCal–about a year and a half ago, after I came across the research on AlgaeCal during my normal scanning of the latest studies published on bone health, I decided to try it. I changed nothing else in my personal bone building regimen — and my bone density went up significantly in both my spine and hip within just 6 months. I am now barely osteopenic and will definitely continue to rely on AlgaeCal! Daily dose of AlgaeCal is 4 pills, 2 am and 2 pm. To determine how much supplelmental calcium your sister needs to reach 1,200 mg/day, you must look at her diet and see how much she is already getting from the food she typically consumes; I explain how to do this and provide tables listing the foods rich in each nutrient and how much is in a typical serving in Your Bones.
Re strontium citrate–I highly recommend this and hope the reasons provided in this blog explain why.
A final thought – SOMETHING is causing excessive inflammation in your sister’s body. The key question for her health overall (including her bones) is to determine WHAT THIS IS. My best recommendation for you is to work with a “Functional Medicine” doctor who can help you figure this out and correct it. You can find these highly eductated, cutting edge physicians via the Institute for Functional Medicine, which provides on-going medical education and certification in functional medicine for doctors and offers a referral service for patients across the U.S. (and in many countries around the world). Here is a link to the IFM:
I very much hope this helps and wish for you and your sister the best of health in 2013, Lara


Hi Lara. I have not read anything about whether unbalanced hormones and menopause have any affect on bone loss. I will be 57 soon and am post-meonpausal for 5 1/2 years. I also have severe osteoporosis. I had my first DEXA scan in 2009 and found out then that I had osteoporosis. My naturopath MD and I are trying to figure out how/why I have it so severely. About 1 1/2 weeks ago she started me on bio-identical hormones (estradiol under the tongue), and progesterone in pill form, to see if they will help. I also take many supplements including 500 mg strontium, calcium citrate and di-calcium malate, magnesium citrate and glycinate, D3, K1 K2 (MK-7),potassium, Vit. E, EPA/DHA/Omega3, greens superfoods powder, Vit. C, and I eat healthy – no dairy, some meat and eggs, no nightshade vegetables,and more vegetables than fruits. Please comment mostly on the bio-identical hormones and menopause. Thank you.

Lara Pizzorno

Hi Barb,
Yes, both estrogen and progesterone play important roles in healthy bone remodeling and the drop off in their production with menopause contributes significantly to bone loss; however, MANY factors cause excessive bone loss — I cannot discuss them all here, but have done so in my book, Your Bones. While you are taking some very helpful nutrient supplements, you may not be taking them in the right amounts for YOU. I explain how to determine what YOU need in the book. And also there are many lifestyle factors that contribute to bone loss you may not be aware of but which could be causing problems for you — also discussed in the book. It’s several hundred pages–I cannot possibly sum it all up here, but you can get this at your library if you do not wish to purchase a copy. PLEASE read up! Also, it’s great that you are going on BHRT — but to do so properly, you really should be tested to see where YOUR hormone levels are and thus what YOU, specifically, need as your level of hormone replacement. I also discuss this in Your Bones. And highly recommend you also read another book (dreadful title, excellent book) by Dr. Jonathan Wright, MD, called Stay Young and Sexy with BHRT (Smart Publications). This book goes into everything about BHRT in depth, and it is easy, even entertaining to read. You really need to understand what you are doing with BHRT and how to get the best results from it. For example, it is MUCH better for numerous reasons discussed in both Your Bones and Stay Young & Sexy, to not take hormones sublingually or orally — you should be taking them in a topically applied cream form, and they should be compounded for YOU specifically to meet your individual needs AFTER you have had the tests run to determine what these are. The test you need run is a 24 Hour Comprehensive Urine Hormone test — this test is run by Meridian Valley Labs (they send you a test kit, and you mail in the samples). When you take hormones orally (even if sublingually, most of them will be swallowed), they are first sent via your digestive tract to the liver where they are processed into different forms before being delivered throughout your body; when you apply them in the form of a topical cream, they go into your circulation without being changed first. The effects are NOT the same from orally vs topically applied BHRT. If your doctor is not familiar with this testing, Meridian Valley Lab has physicians on staff who will walk her through your test results over the phone and teach her what she needs to know — this service is free to physicians. I very much hope you will read the books and have this test run — Wishing you a happy and healthy 2013, Lara


I am 22 weeks pregnant and started taking Garden of life grow bone after 16 weeks. I just noticed the warning on the label 🙁 . Does anyone have any information about the dangers to my baby?

Lara Pizzorno

Hi Esther,
I am not familiar with the Garden of Life product — what are they saying may be harmful to a growing fetus?


Dear Lara,

I have just found out that a dear friend has a rare bone cancer Osteasarcoom. She is only 18 years of age, also it is secondary cancer not the primary.

Could you please explain the differences between Osteasarcoom and Osteaporosis as they both are located in the bone.

Is their anyway to keep the bones healthy or even cure Osteasarcoom, as the doctors have said it is uncurable.

Will Algaecal help fight the Osteasarcoom and keep the bones strong and even cure this awful disease.

Could you please give detailed information about this, I would really appricate this.



Farah Kamal

Hi Lara, I am recently diagnosed with Oestopenea, I live in a part of world with poor health facilities and women health are completely neglected. I went with my BMD report to a bone doctor which prescribed me with Strontium Renalate suspension. However he asked me to stop taking the Calcium supplement (Caltrate 600D) I thought I heard it wrong but he was quiet sure I dont take any calcium supplement. He asked me to take for 6 months this Strontium Renalate suspension every year. Now this really bothers me I am 47 and can’t think of not taking any calcium supplement. I am so so worried and keep awake the whole night. I need your views. Please help me. Farah

Lara Pizzorno

Hi Farah,
So glad you wrote in — your doctor is likely concerned about the fact that calcium competes with strontium for absorption — and calcium ALWAYS wins, which translates to less strontium being absorbed when calcium is also consumed AT THE SAME TIME. What you want to do is take your strontium at a time of day when you are NOT consuming any calcium. I take my supplemental calcium when I brush my teeth in the morning and at night; I take my strontium with lunch, and try to be careful not to consume foods rich in calcium for lunch. Other women have written me that they find it easier to take their strontium at night, right before bed, so several hours after they have eaten dinner. You’ll know what will work best for you — just find a time of day when you can take your strontium several hours (3 – 4 hours would be ideal) apart from consuming calcium.
Your bones do need calcium! Please do continue to consume calcium — the recommended daily intake is 1,200 mg. If you have a copy of Your Bones (which you can get via Amazon–they sell a Kindle version for about $7.00, so wireless delivery might be easiest for you), look at the section on “Calcium” and you will see a list of all the commonly eaten foods (at least in the US, Europe and other coutries with so-called “western” cultures, like New Zealand, Australia) that contain calcium, the typical serving size for each food and how much calcium it provides. You can use this list to estimate how much calcium your diet is typically supplying each day, then subtract this amount from 1,200mg and take the remainder in the form of a calcium supplement. For example, if your diet is giving you 400 mg of calcium each day, then you need to take 800 mg of calcium in the form of a supplement.
I expect it may not be possible for you to ask for strontium in its natural form of strontium citrate, rather than the drug form, strontium ranelate? If you do have a choice, PLEASE use the natural form of strontium. The drug form has been shown to greatly increase risk for venous thromboembolism (blood clot formation in the deep veins — very dangerous) and DRESS syndrome (if you develop a rash while taking strontium ranelate, see your doctor IMMEDIATELY; DRESS syndrome is very serious, requires quick treatment and possibly hospitalization).
I applaud you for taking action to become well informed and make the best decisions you can for your own health. You are a brave and intelligent woman! Hopefully, you can share what you learn and help others in your country as well. Don’t hesitate to write if I can be of further help, Lara

Farah Kamal

Dear Dr. Pizzorno, I woke up today to find your email response to my question, and was pleasantly surprised that my email actually got a response and that too so personal and informative and such a good medical advise and details

I immediately started with my Calcium this morning at breakfast, I take Strontium 2 hrs after lunch everyday.
Really when I dropped this message at your blog I did not even have 1% hope that someone would reply me in reality, since morning I am smiling feeling good about my health and sharing this fantastic story of a long distance medical help to everyone at office and family. Doctors in our part of the world usually wont talk and discuss the issues much with their patients or bother to reply to their questions even after massive fee that they charge. So to me you are like an angel.
Next month I will be USA for a conference and if you can give me name of some supplementry or some other brand of natural form of strontium, I can bring those back with me.
Many many thanks for your help once again.


Thanks once again.

Lara Pizzorno

Good morning Farah,
SO delighted to have been able to give you helpful information! What you are now doing sounds just fine, although a number of other nutrients are required for optimal bone health — you should also be getting adequate vitamin D3, vitamin K2, boron, magnesium and vitamin C — plus a wide range of trace minerals. I have discussed all of the nutrients bone requires and how to determine how much you need of each in Your Bones. If possible, please try to get a copy. I have also discussed many things that contribute to bone loss that you may not be aware of, and which you can avoid once you know about them. Here in the US, Your Bones is available in our public libraries. If you do not wish to own a copy, you might be able to have a friend here check it out for you to read while you are visiting.
I am happy to suggest some choices of natural strontium supplements for you. I, personally, use AlgaeCal’s strontium supplement; I know AlgaeCal has the highest standards for its’ supplements purity and potency, but other companies here also offer strontium citrate. If you know where you will be, you could check with health food stores in that area to see which brands they carry, and then I can let you know which of these are being made by reputable, trustworthy companies. I am not a physician. My husband is — Dr. Joseph Pizzorno. I am a medical writer and have been a member of the AMWA (American Medical Writers Association) and have been writing medical journal articles and medical books for doctors and for the public for 30+ years now, so I am very well educated, and I also work with my husband, but I am not a doctor. I do have 2 graduate degrees — one in Philosophy/Theolgy from Yale University and a second master’s in English from University of Washington. In addition, I am an LMT and am currently finishing my STOTT Pilates certifications. You can Google us if you want our full resumes.

Farah Kamal

Lara, where can I order this book Your Bones. F

Lara Pizzorno

Hi Farah, as I explained in responding to your primary question — Your Bones can be ordered via Amazon, and a Kindle version is available there as well as hard copy. In the U.S., Your Bones was approved by our library book review system and is available in our public libraries as well.


Dear Lara,

I have just found out that a dear friend has a rare bone cancer Osteasarcoom. She is only 18 years of age, also it is secondary cancer not the primary.

Could you please explain the differences between Osteasarcoom and Osteaporosis as they both are located in the bone.

Is their anyway to keep the bones healthy or even cure Osteasarcoom, as the doctors have said it is uncurable.

Will Algaecal help fight the Osteasarcoom and keep the bones strong and even cure this awful disease.

Could you please give detailed information about this, I would really appricate this.



Lara Pizzorno

Hi Vimal, I am so sorry to hear this and wish I could offer you something helpful to try, but osteosarcoma, a cancer of the bone, is not at all related to osteoporosis, which is bone becoming thin and porous due to an imbalance in bone remodeling (break down and renewal) caused by numerous contributing factors (which I write about in Your Bones in detail). I do have one suggestion for you — you might get in touch with Cancer Treatment Centers of America. This medical group utilizes integrative medicine to support health while treating cancer. Here is a link to their main website: AND another link to their contact page:

Kathy Graham

Great article.

Is there interference with iron or magnesium absorption if taken with strontium?

Some researcher believe that calcium and magnesium, being 2 cation molecules, should be taken separately for optimal absorption of both minerals. Your article clearly shows that strontium and calcium should be taken separately. What about iron and magnesium regarding strontium?


Lara Pizzorno

Hi Kathy,
Great question! I have seen nothing in the recent research to indicate competition for absorption between strontium and iron or magnesium. However, I did find one paper, a rat study published in 1963, that considered competition between strontium and magnesium as well as calcium, and results suggest that competition does occur:
PMID: 14099733
As you likely know, rat and human absorption mechanisms are similar, albeit not equivalent. Here’s a recent paper on this:

Pharm Res. 2006 Aug;23(8):1675-86.
Why is it challenging to predict intestinal drug absorption and oral bioavailability in human using rat model.
Cao X, Gibbs ST, Fang L, Miller HA, Landowski CP, Shin HC, Lennernas H, Zhong Y, Amidon GL, Yu LX, Sun D.

Source: Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, Ohio 43210, USA.


PURPOSE: To study the correlation of intestinal absorption for drugs with various absorption routes between human and rat, and to explore the underlying molecular mechanisms for the similarity in drug intestinal absorption and the differences in oral bioavailability between human and rat.

MATERIALS AND METHODS: The intestinal permeabilities of 14 drugs and three drug-like compounds with different absorption mechanisms in rat and human jejunum were determined by in situ intestinal perfusion. A total of 48 drugs were selected for oral bioavailability comparison. Expression profiles of transporters and metabolizing enzymes in both rat and human intestines (duodenum and colon) were measured using GeneChip analysis.

RESULTS: No correlation (r(2) = 0.29) was found in oral drug bioavailability between rat and human, while a correlation (r(2) = 0.8) was observed for drug intestinal permeability with both carrier-mediated absorption and passive diffusion mechanisms between human and rat small intestine. Moderate correlation (with r(2) > 0.56) was also found for the expression levels of transporters in the duodenum of human and rat, which provides the molecular mechanisms for the similarity and correlation of drug absorption between two species. In contrast, no correlation was found for the expressions of metabolizing enzymes between rat and human intestine, which indicates the difference in drug metabolism and oral bioavailability in two species. Detailed analysis indicates that many transporters (such as PepT1, SGLT-1, GLUT5, MRP2, NT2, and high affinity glutamate transporter) share similar expression levels in both human and rat with regional dependent expression patterns, which have high expression in the small intestine and low expression in the colon. However, discrepancy was also observed for several other transporters (such as MDR1, MRP3, GLUT1, and GLUT3) in both the duodenum and colon of human and rat. In addition, the expressions of metabolizing enzymes (CYP3A4/CYP3A9 and UDPG) showed 12 to 193-fold difference between human and rat intestine with distinct regional dependent expression patterns.

CONCLUSIONS: The data indicate that rat and human show similar drug intestinal absorption profiles and similar transporter expression patterns in the small intestine, while the two species exhibit distinct expression levels and patterns for metabolizing enzymes in the intestine. Therefore, a rat model can be used to predict oral drug absorption in the small intestine of human, but not to predict drug metabolism or oral bioavailability in human.

PMID: 16841194

Bottom Line — for best absorption, take strontium separately from other minerals. I’ve now heard from a number of women who find it simplest to take their strontium supplement right before going to bed — so around 4 hours after their evening meal. This would avoid any competition and promote optimal bone benefit from strontium.
Hope this helps, Lara


Hi so glad i found this site , my mom has exstensive bone marrow edema in 234and 5th matataresial bones in her foot also in the landrum of the foot shes 52 her bone density test came back low we are doing more blood work now the injury happened in october not sure how she has no fractures pain has now gone to her knees and she cant walk at all she always has poor eating habits smked and drinked most of her life nothing was helping the pain shes been on high calcium and vitamins for about a month now i started useing bone growth formula for her which she takes a strontium on an empty stomach so we tried Giving her a little more then 1000mg of it and its really gave her pain relief where no pain killer did we also started adding milk thistle and colostrum on an empty stomach first thing in the morning her insurance does not start till may 1st the problem is her xray on 11/19/12 the foot bones were all white next xray on 1/17/13 the bones seem to be turning black or OSTEONECEROIS MAYBE, ALMOST 90 DAYS TO GO IS IT TO RISKY TO WAIT ? PLEASE ANY IFO WOULD BE GREAT SHES SCARED AND HEARTBOKEN

Lara Pizzorno

Hello Amanda,
Please do not wait! I urge you to call your mother’s doctor and make an appointment to be seen ASAP! If you have questions about supportive diet, supplement and lifestyle recommendations, I will do my best to be helpful provide you with useful information, but your mother really needs to be under the supervision and guidance of her doctor.
Let me know how she is doing, Lara

Linda Zarnowski

Hi Lara,

. I have Osteoporosis and am currently taking Algae Cal (360 mg. calcium from algae, 175 mg. magnesium, 732 mg. trace minerals from algae 1.5 mg. boron 800 D3, 50 mcg. vitamin K2 (as MK-7) and 25 mg. vitamin C) every day. I also walk 30 minutes on the treadmill. My t-scores are: beginning in 2007, initial report to 2012 most recent report) as follows: Right Femoral (-3.2 to -3.6), Left Femoral (-2.8 to -3.5) and Spine (-2.1 to -3.2). I am 53 years old. My mom’s bones are strong, but both my sister and I have osteoporosis. I am opposed to medication and want to find the safest, most effective, natural way to help improve my bones. I have discussed this with my general doctor. He explained that strontium is probably not half bad, but there is not enough information about it. My most recent blood work showed that my Vitamin D was 41.9, my B12 was 1058, my TSH was 1.500 and my Alkaline Phosphatase was 84. Is strontium dangerous to your kidneys since I had a kidney stone in the past? How do you take strontium so it is properly absorbed? Does strontium cause blood clots? Is strontium safe? How much should be taken? Is Strontium Citrate 2230 mg. (680 mg. of elemental strontium) an effective dosage? Can strontium cause cancer?

I welcome any information that you can provide me and hope that you can answer my questions and provide me with more insight into the effectiveness of strontium and other natural ways to help my bone density. Please provide your answer.

Thanks so much for your assistance and for your concern in helping me to be a healthier individual!

Lara Pizzorno

Hi Linda,
Natural forms of strontium (eg, strontium citrate) are safe and helpful for improving bone density and strength. There are no reports of strontium citrate (or other natural forms of strontium) causing kidney stones or any other issues when strontium is consumed along with a diet and supplements providing approximately twice as much calcium as strontium — i.e., 1,200 mg of calcium and 680 mg of elemental strontium daily. If you take another look at this blog, you will see I have discussed the issues raised regarding strontium’s usage and have reviewed the research conducted on strontium over the last 100 years here. It is important to take strontium at a time of day when you are NOT consuming calcium as these two minerals compete for absorption, and calcium will always triumph, so you will get far less benefit from your strontium if you consume it along with calcium.
Your vitamin D is well below optimal – which is 60-80 ng/mL. K2 (as MK-7) should be taken in a dose of at least 90 mcg per day; research has shown no ill effects from consuming more than 400 mcg of MK-7 daily. IF you formed kidney stones in the past, this suggests that you may require more K2 than the “average” person since K2 is the nutrient responsible for activating the protein (called Matrix Gla Protein) that keeps calcium from depositing in soft tissue (our blood vessels, heart, breasts as well as kidneys) as well as the protein (osteocalcin) that helps deposit calcium in bone.
To take good care of your bones, you must become well educated about what bones need — and what causes excessive bone loss to occur. I have explained both in detail and how to figure out what YOUR specific issues and needs are in my book, Your Bones. THis book is available at libraries throughout the U.S. — PLEASE consider checking it out and reading it — or purchasing a copy on Amazon — I think the Kindle version sells for about $7.00 and the paperback for around $9.00. You are likely to identify a number of potential causes for your and your sister’s excessive bone loss in your lifestyle and diet; I wish I could magically know all about you and be able to tell you what YOU need, but obviously, this is impossible via a blog! When you have read a bit more and have questions, please feel welcome to ask me.

Linda Zarnowski

Thank you Lara for getting back to me so promptly. I just ordered your book on Amazon and am looking forward to reading it. Based on the information that you have provided thus far, I will increase my intake of vitamin K and vitamin D. I plan to read more about natural strontium, so I can be more informed before starting to take this supplement too. Thanks so much and I look forward to discussing this with you more after reading your book.

Lara Pizzorno

Hi Linda
You are so welcome! Happy to do my best to answer any questions you have. Keep me posted on how you are doing. Be well! Lara

Sylvia Ross

Hi Lara
I have followed all of the comments and your very detailed responses to many who have sought answers from you. I have read Your Bones – and decided to purchase AlgaeCal Plus and Strontium Boost – my package arrived today. I was disappointed to read the disclaimer on labels on both bottless – “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” I am also disappointed that the AlgaeCal Plus contains Calcium Carbonate … My family doctor advised me to take Calcium Citrate. Lara – I guess my question is – Does the body absorb Calcium Citrate more readily – or is AlgaeCal Plus absorbed easier because of the other minerals, etc. contained therein ??
Thanks for the help — I will start on the AlgarCal today – and hope to have a BMD test in about four months (my regular scheduled followup). Thanks for the guidance.

Lara Pizzorno

Hi Sylvia,
The disclaimers are standard legaleeze on all supplements, not just AlgaeCal. Re calcium carbonate vs citrate — if you are not producing sufficient stomach acid, you will have a harder time absorbing calcium carbonate than calcium citrate. And MANY of us over age 50 are not producing optimal amounts of stomach acid, which I why I wrote about this in Your Bones and suggested taking calcium citrate if taking calcium as a stand-alone supplement. This is also why it is best to take your supplements with a meal because in response to the food, your stomach is going to secrete hydrochloric acid (unless you are using acid blocking drugs which will inhibit –eg Tums; greatly inhibit, H2 blockers eg., Pepcid; or totally shut down, proton pump inhibitors, eg., Nexium — your stomach acid production. AlgaeCal has now been shown in several large human clinical trials to not only be effectively absorbed but to promote bone formation much more effectively than calcium citrate. Certainly, the beneficial roles played by the numerous trace minerals naturally present in AlgaeCal contribute. So does the D3, K2, additional boron and magnesium present in AlgaeCal Plus. I have written several pages about the research conducted on AlgaeCal in the 2nd edition of Your Bones — it lab research using human osteoblast cells, it was shown to be more effective (200-400% more effective) than calcium citrate via a number of mechanisms. Reading these studies was what convinced me to try AlgaeCal myself. I had been using calcium citrate. After 6 mos. of using AlgaeCal, I was due for my next DXA and my results were really stellar. I went from clearly osteopenic to barely osteopenic and since switching to AlgaeCal was the only change I made in my bone health regimen, I am sure it played a key role in my improvment. I’m due for my next DXA in about 6 months (I only run them once a year) and expect it to be even better. AlgaeCal is the foundation of my bone support supplements, but as I explain in Your Bones, each of us is different, so just as I require more vitamin D and K than the “average” person and more than is supplied only by AlgaeCal Plus, you may also require more of some nutrient. I urge you to both take the AlgaeCal Plus and Strontium Boost supplements AND to take a good look at your diet and all the factors I discuss in the book that promote or mitigate against bone health, so you can figure out what YOU specifically need for your optimal bone support. Do let me know how your BMD test comes out — Be well! Lara


I was taking 680 strontium citrate, 1130 calcium and 450 magnesium citrate. My hair started falling out and I read it might be the strontium so I cut back to 380 strontium. Now I’m reading that I might need more magnesium with so much calcium and wonder if you figure-in the strontium AND calcium to balance the magnesium. What are your thoughts on the amount of magnesium to calcium/strontium? (also, my blood pressure was rising significantly – enough that my Dr put me on blood pressure meds)

Lara Pizzorno

Hi Pam,
You should not be consuming more than 1,200 mg of calcium TOTAL daily from BOTH the foods you eat AND supplements. You should be consuming at least 600 mg/day of magnesium (from both food and supplements) for the 1,200 mg of calcium. Calcium and magnesium balance one another in many, many activities in our bodies. I think the ratio should be 2/3 as much magnesium as calcium rather than 1/2 as much — and this is what I take myself – 2/3 as much magnesium as calcium. If you have a copy of Your Bones, please read the sections on both calcium and magnesium. Also those on vitamin D and vitamin K2, both of which are essential for ensuring proper absorption and utilization of calcium and magnesium. If you don’t have a copy, please check it out from your library if you don’t wish to buy it. PLEASE read up! From what you write, it is apparent that you are not meeting your needs for magnesium, unless you are eating a diet VERY rich in magnesium AND your digestion and absorption are excellent. Magnesium needs are increased by stress. Hair loss can also be the result of chronic stress. I remember when my mother was dying from hip fracture + congestive heart failure — along with my 23 year old cat, who we were giving fluids several times a day because of her kidney failure — I was so stressed out and sad that I lost TONS of hair. It took several years for my hair to fill back in. It did though.
I have never seen anything suggesting strontium causes hair loss. Still, cutting back to 380 mg elemental strontium per day is reasonable — at this amount, it will still be helpful for your bones. Be sure to take it when you are NOT also taking calcium or consuming calcium-rich foods.
Be well! Lara

Dennis Radecky

My wife has been following the AlgaeCal Plus program for just over 1 month. Today 2/27/13, I took her to the ER. She had a Kidney Stone. Could this stone have been caused by the AlgaeCall supplement?

Lara Pizzorno

Hi Dennis,
Highly unlikely that her kidney stone is due to taking a calcium supplement. Kidney stone formation is almost certainly due to insufficient vitamin D (please have your wife’s levels of 25(OH)D checked ASAP–optimal levels are 60-80 ng/mL, and vitamin K2. Vitamin D increases our body’s ability to absorb calcium; vitamin K2 activates the proteins responsible for putting calcium into bone (osteocalcin) and keeping it OUT of arteries, kidneys, breasts. Few labs at this time are checking levels of unOC (uncarbocxylated osteocalcin) — you want these levels to be low as uncarboxylated osteocalcin is the form in which osteocalcin is NOT activated to pull calcium into bone). Your wife should be getting at least 120 mcg of MK-7 form of K-2 daily. Is she taking Coumadin? This drug prevents vit K recycling and, as a result, promotes calcium deposition where we do NOT want it — in coronary arteries and kidneys.

Terry Williams

Dear Lara,
I am an Australian male aged 69. I am currently on Fosamax as prescribed by my doctor as I have painful fractures in my spine and have been diagnosed with Osteoporosis.
My mother was on Fosamax and my older brother is on Fosamax. They both had severe hip fracture after 5 years on Fosamax. I don’t want to follow in their footsteps

I asked my doctor about Strontium citrate and I received a very learned lecture encouraging me to stay away from untested drugs that may cause unwanted bone growth-in the wrong places. He also said that Strontium Ranelate works by combining with Oestrogen and therefore is unsuitable for males

Can a male with Osteoporosis take Strontium citrate?. Should I continue with Fosamax?
Hope you are able to shine some light in my direction

Terry Williams

I have not received a response as yet. I have ordered your latest book online, and hope that by reading it I may get some guidance. I have done a lot of research online and there are trials currently underway at the West German Osteoporosis Centre that seem to indicate benefits to males with Osteoporosis, especially reduction in pain.

Lara Pizzorno

Sorry Terry — for some reason, I did not receive your question earlier. How can I say this “politely”? Guess I can’t. Your doctor is misinformed and needs to read the current medical research. You might loan him your copy of Your Bones, 2nd edition or just send him to AlgaeCal’s website to read this blog post. He can check out the references provided and get updated. Strontium citrate is safe, will not cause bone deformities — you do need to consume more calcium than strontium, twice as much calcium as strontium is recommended. You are absolutely correct that Fosamax (or other bisphosphonate or densoumab or teriparatide) are NOT the way to develop healthy strong bones! I promise you that the 2nd edition — which includes more than 475 endnotes providing references from peer-reviewed medical journal articles available on PubMed — will provide you with the information you seek and lots of ammunition to use with your doctor. Please write me with any questions you have once you have scanned the book.

Terry Williams

Thanks Lara.
After being on Fosamax for 12 months I have gone on a Fosamax holiday as I have got an unresolved abscess in my lower jaw. My dentist has referred me to a Periodontal specialist, as I have a shadow at the point of attachment of my the left lower incisor ligament that attaches this tooth to my lower jaw. This referral is a result of continued pain that has persisted after having had root canal therapy on this tooth (with extensive difficult treatment). I have ordered and just now received 3 copies of you latest book and have given one to my General Practitioner, one to my Brother (also a Medical graduate – retired, but riddled with Osteoporosis), and one for myself.
One question I have is on page 35 of your book, under the heading “Bishophonates not helpful, may harm, women with breast cancer”. you state in print that ‘ Cancer cells stimulate osteoblasts, this increasing the rate at which bone is lost’. This does not seem to support what I, as a reader, believe is the role of osteoblasts. The first para of this section does not seem to make sense. Can you enlighten please. As I am attempting to get a grasp of the role of our bodies Bio-mechanisms and the effect drugs have on our chemistry.
PS my GP is not impressed with my research. I hope he reads your book

Lara Pizzorno

Hi Terry,
First, please accept my apologies for the lag time in my responding to you. AlgaeCal has been improving their website, and I have been on the road attending medical conferences in Tempe AZ, Banff and Dallas — plus right before I left for AZ, my computer died, so I was reduced to using my iPhone for several weeks. The end result has been that a number of questions did not get to me. I am just now catching up.
Re your comment/question —
WOW — thanks so much for catching this — how embarrassing! I truly did proof read the publisher pre-copy of the 2nd ed, but I managed to miss this obvious error. On page 35, it should read “osteoclasts” NOT “osteoblasts”. You are absolutely right — osteoclasts break down and resorb old bone, while osteoblasts build new bone. Cancer cells stimulate osteoclasts to break down bone because one outcome of this process is that when bone is broken down, nutrients are released that the ever hungry (because they are unnaturally rapidly dividing) cancer cells gobble up to fuel their growth. I will be sending Praktikos (my publisher) a note about this, so that this typo will be corrected in future printings. THANK YOU! Lara

Lara Pizzorno

Hi Terry, please see my response below. Strontium citrate should be helpful for you. You should also check your diet to see how much of the team of nutrients required for bone health it is supplying, and supplement where it is not to ensure you are receiving optimal amounts. You will also want to read through the discussion of the many factors that promote excessive bone loss to identify those which apply to you and eliminate or at the very least ameliorate these. And please read through the Labs Appendix that details the tests that can be run to identify causes of excessive bone loss; after you have used Your Bones to flesh out your optimal bone building program and have been following this for 3-6 months, you should be building bone. If you are not, then use the Labs Appendix to identify the tests that can help you figure out what is still missing or off in YOUR body, so you can correct it naturally and safely. BE WELL! Lara


just got back from my DEXA and i’m in serious trouble! Lumbar -4.6, and -2.9 fem neck. I’m 59, had total hyst. 15 years ago and have very small bones (wear size 4 ring). I absolutely refuse to go on a bone builder drug – see my post above for what I take. My gyno wants me to see an endocrinologist – ran all blood tests including thyroid and have no results yet. Am I going to HAVE to do something drastic?

Lara Pizzorno

Hi Pam,
Please see if your library has a copy of the 2nd edition of Your Bones, read the book and see if you can identify any factors (besides hystorectomy at early age and no BHRT), check the Labs Appendix and discuss possible tests to confirm factors contributing to your bone loss with your doctor. The book publication date is March 16, but I see it is available on Amazon now, so I expect it should also be in libraries already — or will be very shortly. The book’s publisher is a non-profit (Praktikos Publishing), so has done all they can to keep cost for the book down. 2nd edition is more than 100 pages longer than 1st edition but is LESS expensive — $8.75 on Amazon. There is much you can do to determine WHY you have lost so much bone and to correct it naturally. Get very well informed and write me if I can answer any specific questions for you. Be well! Lara


Hi Lara:
I will be getting a dexa scan in a couple of months. I am on your bone building plan from your book and taking Algae Cal and Strontium. Do you have any recommendations before getting the scan as far as discontinuing either the algae cal or strontium or any other minerals or vitamins?

Thank you,

Lara Pizzorno

Hi Barbara — delighted you are getting well informed and taking the best care of your bones (and all the rest of you if you are eating the healthy diet and following the exercise recommendations in Your Bones). You should absolutely NOT stop taking your bone health supplements or any other vitamins or minerals before getting your DXA run! These nutrients are FOOD for your bones. Continue to nourish your bones and your entire body well — every day for the rest of your long, and healthy life! Be gloriously well, Lara


Hi Lara,
I see that in the first edition of “Your Bones” the UL for Calcium is 2,500 mg. but in your recent comment you told Pam that she shouldn’t consume more the 1,200 mg. Am I missing something? Some days I get as much as 1,400 mg. depending on what I eat so I now cut back to 2 AlgaeCal calcium pills a day from 4. I drink milk so it is easy to get enough additional from diet since 1 glass has 300 mg.
I have been on Alendronate for over 10 years but quit almost 9 months ago because I was able to get off Prednisone 7 months ago.
I am having my first NTx test now, so what would be a good result on the test? I hope the bone loss has slowed to where I am replacing with new bone. I will have another DXA soon but I had one about 7 months ago.
I am experiencing pain in hands, arms, fingers and knees at times so I can’t afford to lose any more net bone or fear I will be crippled. I started keeping a diary of supplements and nutrients from my daily diet so I am getting enough of the bone nutrients most of the time.

Lara Pizzorno

Hi John,
2,500 mg is the UL (upper limit) for calcium intake (the amount above which toxic reactions are likely) NOT the RDI (the recommended amount for health) which is 1,200 mg for individuals over age 51. 1,500 mg is the RDI for postmenopausal women not on hormone (and it should defintely be bio-identical hormone) replacement.
Yes, you should absolutely figure out how much calcium your daily diet is supplying, subtract that from the RDI (1,200 mg for a man over age 51) and then see if you need to supplement any to make up the difference.
Are you aware of any other factors in your diet and lifestyle besides Prednisone (which causes bone loss, so glad you are off this drug!) that could be contributing to your bone loss? Please check out Your Bones from your library and read up. How is your digestion? It sounds like you are having inflammatory joint problems, and a very common cause of this is intolerance to gluten and/or dairy products. In the 2nd edition of Your Bones, I included a Labs Appendix discussing the tests you can have run to identify such issues, as chronic inflammation from any source causes bone loss. Suggest you look into EnteroLab’s sIgA stool test for food intolerances. Or you could just try eliminating gluten and dairy foods from your diet for a month and see if your pain goes away.
Let me know how you are doing. Hope this helps! Lara

Linda Zarnowski

Hi Lara,

Recently I bought your book and then learned of your new edition. Is the additional information worth me purchasing it again? Also, I am confused about the correct amount of calcium to take. I believe you mentioned, as well as my doctor, that 1200 mg to 1500 mg is the appropriate amount daily. However, follwoing the Algae Cal suggested does of 2 capsules at AM and PM only equals 720 mg daily. What do you recommend?

Lara Pizzorno

Hi Linda,
I’ve added more than 100 pages to the 2nd edition — other drugs are now being marketed to “treat” bone loss that are even worse than the bisphosphonates that I wanted to discuss, also I updated most all of the research (same overall conclusions drawn, but more data to make the case), and added sections on some of the trace minerals (eg, zinc) and damaging factors (notably fluoride). I also added more on bone-building exercises safe for women with osteopenia, osteoporosis and two appendices — one provides a summary overview of all the nutrients required by our bones and the other is a section discussing all the lab tests important for identifying both whether the program you are following is helping you regain healthy bones and, if not, the potential causes of bone loss. This section is more than 20 pages in length. If someone is following the program laid out in Your Bones and is not rebuilding bone after 3-6 months, then these lab tests are what you want to discuss with your doctor to determine WHY. I was very happy to see that my publisher, a non-profit called Praktikos, managed to keep the cost of the 2nd edition just as low (less than $9 on Amazon) as that of the 1st even though the 2nd edition is more than 100 pages longer. The 2nd edition will also be in libraries, so you can check it out to read if you do not wish to purchase a copy.
Re calcium — the RDI is 1,200 for women over age 51 and 1,500 for postmenopausal women who are NOT taking bio-identical hormone replacement (BHRT). When figuring out how much calcium YOU need to get from a supplement, you must see how much your diet is providing first. Most of us are getting around 400-600 mg of calcium from our typical diet. In 1st as well as 2nd ed of Your Bones, I’ve provided a table listing commonly eaten foods rich in calcium and how much is present in a typical serving. Please take a look at your diet and see how much calcium it is providing for you — then you can adjust your supplemental intake to make up the difference required to reach 1,200 – 1,500 mg/day.
Hope this helps, Lara

Linda Zarnowski

Hi Lara,
I am currently reading Your Bones and plan to purchase your new edition. I started the Algae Cal and Strontium Boost this past week. (Taking 4 Algae Cal and 3 Strontium). I am now also increasing my vitamin K, as you suggested because of previous kidney stones. Current does of K-2MK7 equals 130mcg and I am also taking 3,300 IU of Vitamin D, (41.9) since it was low with my last blood work. I am petit with a height of 5’1″ and a weight of 104 pounds. Am I over doing the amount of supplement in any area for my size? I just want to be sure that my body should take the same daily recommended dose of people who weigh more than I do.

Lara Pizzorno

Hi Linda,
The doses you are taking of these nutrients are at the low end of the safe range. While it is true that size –and age (children’s need vary from those of adults)– do impact nutrient requirements to some degree, your genetic inheritances — the many SNPs that impact how well your enzymes work and how your cells’ nutrient receptors are formed – is at least as important as your size. I am 5’4″ and weigh around 107-110 (I rarely weigh myself, depend more on being able to fit easily into my Size 0 skinny jeans as muscle weighs more than fat, and I have been lifting weights now –a really fun class at my gym called BodyPump — for 3+ years now, so have added muscle), yet I require 10,000 IU/day of vitamin D because my vitamin D receptors are not well formed. And b/c of this, I also require more of other nutrients that balance vitamin D, like vitamin K and vitamin A, than the “average” person. You do not mention how low your vitamin D levels are — you may need even more vitamin D than 3,300 IU per day to get them up into optimal range, which is 60-80 ng/mL. Also, are you taking D2 or D3 — I hope D3 as it is MUCH more effective than D2. Back in March 2011, I tweeted this research when it came out as: D3 ~87% better @↑& maintaining serum 25(OH)D & produces 2-3-fold ↑ vit D storage vs equimolar D2. Heaney et al. 3-11
The 4 capsules of AlgaeCal are supplying you with 1,600 IU/day of D3 — not sure about the other vit D you are taking.


Hi Lara,
I will run a DXA on Monday . I have been taking Strontium citrate since Aug. 30. and it seems I read somewhere that the Strontium exaggerates the results. I can’t seem to find where I read it or how you correct for it. Could you please tell me how to read these DXA results when on strontium.

Lara Pizzorno

Hi John,
I did try to cover this in my blog post regarding strontium; see the section “Strontium impacts DXA results.”
What the research clearly shows is that strontium does increase BMD, although the DXA overestimates how much by aproximately 10%.
Furthermore, the latest studies show that different DXA machines overestimate by slightly differing amounts.
The Hologic QDR systems (Emax = 140 keV), Lunar Expert (135 keV) and Sophos LX-RA (140 keV) all have strontium ratios (i.e., overestimate) in the range 9.8% to 11.1%, the Norland XR-26 (100 keV) overestimate by 10.0%, and the two Lunar DPX systems studied (76 keV) overestimate by 8.3%. (Reference: Liao J, Blake GM, McGregor AH, et al. The effect of bone strontium on BMD is different for different manufacturers’ DXA Systems.Bone. 2010 Nov;47(5):882-7. doi: 10.1016/j.bone.2010.08.005. Epub 2010 Aug 10.PMID: 20699129)
What really matters here is what does this mean for YOU, your risk of fracture?
The research clearly shows that strontium definitely increases BMD and improves bone quality, significantly decreasing fracture risk.
What YOU want to see is improvement in your BMD on the DXA — what this will tell you is that your bones’ BMD and ability to resist fracturing are improving.
Hope this helps, Lara

Linda Wilkins

My doctor just started me on strontium citrate. I also take bioidentical estrogen. I’ve read that estrogens might decrease how fast the body gets rid of strontium and cause side effects. Is this a safe combination?

Lara Pizzorno

Hi Linda,
Both strontium citrate and bio-identical estrogen (likely bi-est) replacement will improve the health of your bones.
Where did you read that estrogens might decrease strontium metabolism? The PubMed research indicates just the opposite is true. In fact, in the one and only study on PubMed I could find suggesing even a remote connection between estrogen and strontium — a rat study involving ovariectomized rats (an animal model for human postmenopausal women) that were given 17-beta-estradiol (a form of estrogen), the rats’ metabolism of strontium normalized. When the animals were not given the estrogen, their metabolism of strontium was greatly slowed down. In other words, estrogen improved the rats’ ability to normally metabolize strontium; it did not decrease it. Whether this animal study even relates to us humans is highly questionable. But if it does, it shows that estrogen helps us metabolize strontium at a normal, healthy rate. (Here is the reference for this study: Ma B, Zhang Q, Wang G, et al. Synthesis and pharmacokinetics of strontium fructose 1,6-diphosphate (Sr-FDP) as a potential anti-osteoporosis agent in intact and ovariectomized rats. J Inorg Biochem. 2011 Apr;105(4):563-8. doi: 10.1016/j.jinorgbio.2011.01.001. Epub 2011 Jan 11.)
Hope this helps, Lara


Hi Lara,
I wonder if I could pick your brain a bit.I’m a 44 yr. old woman with severe osteoporosis,particularly bad in spine.I stopped menstruating in my teens and never took hormones as my drug plan only covered the synthetics,which I will not take.I was tried on Fosamax and Actonel many years ago,but found the heartburn intolerable,and was on Miacalcin for a couple of years until my drug plan funds ran out-actually,reading your blog has made me glad I didn’t continue with these products!.
I do know my digestion is compromised-delayed emptying,terrible heartburn,poor nutrient uptake….I’ve tried digestive enzymes,which seem ineffective,and Betaine HCL ,which caused worse esophagitis as well as gastritis…
My diet consists of mostly fresh veggies and fruit,free-range eggs,legumes,nuts and seeds,gluten-free grains,and coconut products-tho I continue to hear conflicting advice about the saturated coconut fats…Dairy has always been an issue(bloating,heartburn,pain) but just lately I’ve been trying to get in a serving of Greek yogurt every day or two.(again,I’m hearing about the saturated dairy fats being not good-now Dr Furman is saying they contribute to Alzeimers…oh my..)I also take a sprouted rice protein powder,but again hear too much protein is bad for our bones…I’m so confused…
The amout of Calcium from my diet is pretty negligible,I’d say,and you recently said post-menopausal women should be aiming for 1500mg/day.I have been taking supplements but obviously they have been ineffective and wonder if I’d absorb the Algaecal better.I’m thinking I should be aiming for 1200mg a day,but that would be 6 of the Algaecal Plus pills.Not only is the cost frighteneing to me as I’m on a limited income,but I am concerned about the amout of Boron I’d be consuming.From what I’ve read of this mineral,too much is not better…and the product supposedly has trace amounts of boron already along with the algea,never mind what’s been added to the product.
I notice they sell another product,Algaecal Plant +Vit D3,that has no added Boron,but would still contain it as a trace mineral…Could you tell me,if I were to take 4 Algaecal Plus and 2 Algaecal Plant+VitD3,would that give me too much Boron-3mg daily plus the amount contained as trace mineral,plus what I get from food.Also,you said we should be getting 2/3 the amount of magnesium as calcium,so that means I need to supplement with another 340mg of Magnesium,as well as what’s in these pills?
I’ve been taking 100 mg K2 daily ,but lost bone since adding that…I also now planning on adding Strontium citrate.
Though the cost of this is all very overwhelming to me at the moment,I really want to give it a try for a year anyway,if I can find a program that can give me a chance at a better prognosis,and any suggestions you can offer would be most appreciated,thank you.
The doctors want to give me pamidronate infusions and are offering doomsday results if I do not foolow their plan…help!

Lara Pizzorno

Hi Sue,
Glitch in the AlgaeCal system made me unable to reply, but has now been fixed. Sorry.

From what you share with me, I believe you are intolerant to dairy products, may also be reacting to a number of other foods as a result of damaged stomach lining and intestines, may have small bowel bacterial overgrowth, may also have Helicobacter pylori infection. The most important thing for you to do is to connect with a good doctor who can help you figure out WHAT PRECISELY is going on! You must get your digesitve system working well for you before you are going to be able to absorb the nutrients you need for healthy bones — and healthy everything else! I do not know where you live so cannot suggest a referral to a really good doctor for you. Since you do not mention your current doctor providing any suggestions except pamidronate (a bisphosphonate drug), I am guessing this person is not going to be much help. My best suggestion for you is to look at the Institute for Functional Medicine website ( ) to find a functional medicine doc in your area or to go to the American Association of Naturopathic Physicians website ( )and look there. If you can let me know where you live, I can try to give you a referral to someone we know is good who can help you.

Re boron — Why are you concerned about consuming boron? Its RDI is 3-5 mg/day. If your estrogen production is very low, then boron may be especially helpful for YOU since its primary bone building action is to convert estrogen into 17-beta-estradiol, the form in which it most increases our bones’ ability to absorb magnesium. Boron also is involved in the reaction in the kidneys in which vit D is converted into its most active form – the one in which it helps us absorb calcium from the intestines most effectively.

I so hope you take my advice and find a doctor who can help you heal! Let me know if I can help you further in finding a referral, Lara


Thanks for your response and suggestions.
May I ask another question? you’ve not mentioned calcium hydroyapatite in your blog.I know it’s not vegetarian,but it was recommended to me years ago by a compounding phamacist as being the most absorbable.Do you know anything about it’s safety/efficacy and comparison to Algaecal?

Lara Pizzorno

Hi Sue,
I discuss hydroxyapatite in Your Bones, both editions — in 2nd edition, read page 209. I double checked PubMed to see if any further research had been done using this — very expensive — form of supplemental calcium (referred to as MCHC) in which calcium is linked with phosphorus. Research on MCHC’s usefulness appears to be limited to use with dental implants and with some hip replacement surgeries, and in these cases, it has been shown to be helpful. I did not mention it in the blog because MCHC only provides calcium linked with phosphorus. It is true that phosphorus is an essential mineral required by every cell in the body for normal function, and the majority of the phosphorus in the body (about 85%) is found as phosphate (PO4) in bone. But phosphorus is present in virtually every food. In fact, because phosphorus is so widespread in food, dietary phosphorus deficiency is usually seen only in cases of near-total starvation. Phosphate (PO4) is also present in lots of processed “food-like” items, such as soft drinks, where its presence has been linked to increased risk of bone loss. Phosphorus is not a nutrient you need to supplement. In contrast to MCHC, AlgaeCal provides calcium in the full matrix of bone-building magnesium and trace minerals, a number of which we are likely to not be getting from the modern day diet.
Lastly, as indicated by the quote below from a recent medical journal paper (Bonjour JP. Calcium and phosphate: a duet of ions playing for bone health.Am Coll Nutr. 2011 Oct;30(5 Suppl 1):438S-48S.PMID: 22081690), some concerns exist regarding supplementing with phosphorus:
“During growth and adulthood, administration of Ca-Pi in a ratio close to that of dairy products leads to positive effects on bone health. In contrast, when separately ingested as pharmaceutical salt supplements, thus inducing large differences between Ca and Pi concentrations in the intestinal lumen, they might have adverse effects on bone health.”
Hope this helps, Lara


Thanks for this Lara…
I have ordered your book from the library so hope to read it soon.
I wondered if phosphorous in MCHC would be an issue-tho I avoid processed foods/drinks so so can’t imagine I’m getting too much there..
I have ordered 6 months supply of Algeacal but since then have read of the lead content in the product and am most concerned-I have read their response ,but not convinced it’s a good idea to be adding that much lead in a supplement form to this body ,but I’m utterly at a loss as to what to do next,and am disappointe this wasn’t disclosed on their site.And since Candad only covers a DEXA scan once a year,even their ‘guarantee’ would be rendered invalid…I’m now concerned that,even if my bones do improve on this product,I may be putting myself at risk for other issues…I question whether such safety research has been done on this product.
I don’t question your sincerity,however,and do appreciate your sharing of your knowledge.thank you.

Lara Pizzorno

Hi Sue,
Here are the facts re the safety of AlgaeCal in regards to lead:

Numerous clinical studies using AlgaeCal, all of which include toxicology evaluations (which include ensuring safety from lead and any other toxic compound) have been published in different mainstream peer-reviewed medical journals. If you want to read them, just type “algaecal” into the search box on Pubmed.

Because AlgaeCal has been proven safe, Algaecal has received an NDI (New Dietary Ingredient) approval and GRAS (Generally Recognized As Safe) by the FDA (both are posted on AlgaeCal’s home page).

ALL calcium supplements contain tiny tiny amounts of lead; this will include ANY calcium supplement you might take. If consumption of no lead is your goal, then you should not ingest any calcium supplements, period…You’d also better stop eating FOOD, because every vegetable contains lead, too — even organically grown vegetables. According to FDA’s publication, Total Diet Study Statistics on Elements Results (December 11, 2007):

Food Amount of Lead in a 4 Ounce Serving
Mixed nuts, roasted 10.2 mcg
Brussels sprouts, fresh, boiled 7.9 mcg
Sweet potato, fresh, baked 7.2 mcg
Spinach, boiled 7.0 mcg

In comparison, AlgaeCal contains LESS than food — just 5.2 mcg in a daily serving. So, if this amount is sufficient to make you concerned about taking AlgaeCal, you’d best stop eating nuts and veggies. I haven’t researched meat, but almost certainly, it will contain microgram amounts of lead since the animals eat grass & grain, which are necessarily grown on soils – and all our soils contain tiny tiny amounts of lead. Lead is a natural element ubiquitous in the soil, water, and air, and we cannot escape ingesting tiny amounts of this toxin every day. The US Government’s Centers For Disease Control publication “Inorganic Lead Exposure, Metabolism and Intoxication” states that “…typical intakes of lead from food, beverages and inhaled air are in the order of 300 – 500 mcg per day.”

Fortunately, our bodies are capable of processing these tiny exposures, which as you can see, are many many times greater than the amount of lead found in a daily dose of AlgaeCal. We know how tiny the amount of lead is that is present in AlgaeCal — I feel very comfortable with this. Frankly, I’d like to see reports detailing how much lead is present is other calcium supplements being sold to us; such reports are glaringly absent. I am confident none will contain less lead than is found in AlgaeCal.

Much dis-information has been posted about this, and it has caused much needless distress — for you and many others. I do not understand why the people trying to frighten us from using a healthful product like AlgaeCal are doing so. They should be ashamed of themselves. It is a huge disservice. I hope knowing the actual facts puts your mind at ease.


thanks for this Lara

Lara Pizzorno

Hi Sue,
You’re very welcome. I hope this post will be read by others who have been caused needless distress by the highly misleading statements made about AlgaeCal. Be well!


just wondering if you got my email?


Hi Lara,
Just got the results from my DXA scan and they are disappointing. The previous scan was 7 months ago and since then I have a decrease in density. -2.4% in the hip.
This is in spite of using Strontium Citrate and AlgaeCal, Vitamin D3, Magnesium, Vit. C and B vitamins. I have kept a diary of my nutrient intake as well to make sure I get close to the right amount.
So, it looks to me like Alendronate is my last resort. I have joint pain which may contribute to the excess Osteoclast activity. My T score is -3.9 spine, -1.5 total hip, -2.2 F Neck, -1.3 F Troch. The Z scores are slightly less but I don’t know what they mean. I have been off Alendronate since June 11, 2012 and off Prednisone since Aug.1. Do you have any ideas as to what is going on and the best course of action? Could it be that all the old bone kept by years of Alendronate use has to be removed before new bone can be laid down? If that is the case then I may have virtually no bone left before replacement can begin.

Lara Pizzorno

Hi John,
Yes, your body is hopepfully now removing the old, brittle bone kept in place by alendronate, and the removal process is faster than the rebuilding process. No, you do not have to remove all the old bone before your body begins to lay down new bone. Nonetheless, it is obvious that something is very much off — joint pain indicates significant chronic inflammation, and as you know, chronic inflammation results in chronic excessive elevation of osteoclast activity. You need to figure out WHAT IS CAUSING YOUR INFLAMMATION and joint pain. As one of my dear friends, Dr. Sidney Baker, MD, explains to his patients, “If you are sitting on two (or more) tacks and remove one, you do NOT get a 50% reduction in pain!” You need to remove all the tacks for your bones to heal. The first thing I would look into is gluten intolerance as gluten (the allergenic protein in wheat [and barley, spelt, kamut, and oats unless specified as gluten-free oats] is a very common cause of joint inflammation– I would also check into reactions to other commonly allergenic foods such as dairy, soy, & corn. What is your diet like? Are you consuming a lot of processed, sugary and pesticide or chemical-preservative, flavorings, etc.-laden foods? Are you eating GMO foods? What is your digestion like? Do you digest your foods easily or suffer from indigestion? You may not be producing adequate hydrochloric acid to properly digest your food and absorb nutrients. Are you currently taking any other drugs that suppress symptoms but do not deal with the causes of the problems they temporarily mask? In the 2nd edition of Your Bones, I added a 32 page appendix discussing all the lab tests you can consider running (and should discuss with your doctor) if you are doing everything I lay out in Your Bones and after 3-6 months are not building bone. I cannot copy in the whole 32 pages here but urge you to get a copy (I believe you can check it out from your library, but on Amazon, the cost for the book is $9.39 right now — as low as $7.85 (this is one of the joys of writing for a non-profit publisher! they have kept the cost of the book even lower than the 1st edition even though I added more than 100 pages of new material). PLEASE look into some of the things I mentioned here – and read through the Labs Appendix — let me know what you are thinking and I will do my best to help you get some ideas about what might be going on, so you can discuss them with your doctor, Lara


Hi Lara, you have mentioned your improved BMD DEXA results after taking Algaecal products including strontium. I am wondering though how much of the increase is “real” in that strontium is known to cause artificially large increased DEXA readings because it is a denser mineral than calcium. So how can the real amount, if any, of increase in strength and quality of bone be known or determined? It is only real increases in strength and quality of bone that can reduce fracture risk, rather than numbers produced by a scan that has known shortcomings, even without considering strontium. Maybe animal studies?

Lara Pizzorno

Hi Peter,
Well, I have to admit that I often forgot to take my strontium (and still often forget to take it as I try to take it at lunch time and am frequently working or out then) — so it was the AlgaeCal Plus that made the difference for me. However, I believe my gains in BMD would have been even greater had I been consistently taking the strontium. Researchers have looked at strontium’s effects on bone quality in animal and human studies, and it has been found to improve bone quality as well as density. Below, I’ve copied in for you two abstracts of recent papers discussing this. The first is a review paper looking at animal (monkey) and human studies and the second is an animal (rat) study.

Osteoporos Int. 2003;14 Suppl 3:S19-24. Epub 2003 Mar 18.

The mineralization of bone tissue: a forgotten dimension in osteoporosis research.

Boivin G, Meunier PJ.


Laboratoire d’Histodynamique Osseuse, Faculté de Médecine R. Laennec, 69372, Lyon Cedex 08, France.


Osteoporosis treatment should not only prevent the loss of bone tissue, not interfere with apatite and avoid bone mineral changes at the crystal level, but should also increase the mechanical resistance of bone and thus protect the skeleton against new fractures. Mineral substance is crystallized as nonstoichiometric carbonated apatite ionic crystals of small size and extended specific surface. Consequently, they have a very large interface with extracellular fluids, and numerous interactions between ions from the extracellular fluid and ions constituting apatite crystals are thus possible. It is generally agreed that bone strength depends on the bone matrix volume and the microarchitectural distribution of this volume, while the degree of mineralization of bone tissue is almost never mentioned as a determinant of bone strength. We now have evidence that the degree of mineralization of bone tissue strongly influences not only the mechanical resistance of bones but also the bone mineral density. In adult bone, our model is based on the impact of changes in the bone remodeling rate on the degree of mineralization of bone tissue. The purpose of this paper is to report the main results concerning the interactions of strontium (Sr) with bone mineral in animals and in osteoporotic women treated with strontium ranelate (SR). These studies aimed to evaluate using X-ray microanalysis, X-ray diffraction and computerized quantitative contact microradiography: (1) the relative calcium and Sr bone content, (2) the distribution of Sr in compact and cancellous bone, (3) the dose dependence of the deposition of Sr in bone, (4) the interactions between Sr and mineral at the crystal level (in monkeys), (5) the influence of Sr on the mean degree of mineralization of bone tissue and on the distribution of the degree of mineralization of bone tissue, and (6) the bone clearance of Sr over short periods of time (6 and 10 weeks) after cessation of SR administration (monkeys treated for 13 and 52 weeks, respectively). In monkeys killed at the end of exposure (13 or 52 weeks), Sr was taken up in a dose-dependent manner into compact and cancellous bone, with a higher content in new bone than in old bone. The Sr content greatly decreased (about 2-fold) in animals killed 6 or 10 weeks after the end of treatment but this affected new bone almost exclusively. After SR treatment, there were no significant changes in crystal characteristics. Easily exchangeable in bone mineral, Sr was slightly linked to crystals by ionic substitution (generally 1 calcium ion substituted by 1 Sr ion in each unit cell). The degree of bone mineralization was not significantly different in the various groups of monkeys. Thus, at the end of long-term SR treatment and after a period of withdrawal, Sr was taken up in a dose-dependent manner into new bone without alteration of the degree of bone mineralization and with no major modification of bone mineral at the crystal level. In postmenopausal osteoporotic women treated with SR (0.5, 1 and 2 g/day) for 2 years, Sr was dose-dependently deposited into new bone without changes in the degree of mineralization of bone tissue. These findings could reflect dose-dependent stimulation of bone formation and are of potential value for the use of SR in the treatment of osteoporosis. In conclusion, the different studies performed on bone samples from monkeys and humans treated with various doses of SR showed that Sr was heterogeneously distributed between new and old bone but in a dose-dependent manner without alteration of the crystal characteristics and the degree of mineralization of bone tissue, even after long-term administration of often high doses of SR (the highest therapeutic dose used in humans is 4-fold lower than the lowest experimental dose administered to monkeys). This emphasizes the value, as antiosteoporotic treatment, of SR, which is safe at the bone mineral level.

PMID: 12730799

Here is an animal (rat) study showing strontium improves bone quality as well as BMD:

J Bone Miner Res. 2004 Dec;19(12):2012-20. Epub 2004 Sep 13.

Strontium ranelate improves bone resistance by increasing bone mass and improving architecture in intact female rats.

Ammann P, Shen V, Robin B, Mauras Y, Bonjour JP, Rizzoli R.


Service of Bone Diseases, World Health Organization Collaborating Center for Osteoporosis Prevention, Geneva 14 CH-1211, Switzerland.

Erratum in
J Bone Miner Res. 2005 Mar;20(3):548.


Strontium ranelate given to intact rats at doses up to 900 mg/kg/day increases bone resistance, cortical and trabecular bone volume, micro-architecture, bone mass, and total ALP activity, thus indicating a bone-forming activity and an improvement of overall bone tissue quality.


Various anti-osteoporotic agents are available for clinical use; however, there is still a need for drugs able to positively influence the coupling between bone formation and bone resorption to increase bone mass and bone strength. Strontium ranelate (PROTELOS), a new chemical entity containing stable strontium (Sr), was tested for its capacity to influence bone quality and quantity.


The long-term effects of strontium ranelate on bone were investigated in intact female rats treated with various doses of strontium ranelate (0, 225, 450, and 900 mg/kg/day) for 2 years. In a second series of experiments, the effects of 625 mg/kg/day were evaluated in intact male and female rats for the same period of time. Bone mineral mass and mechanical properties were evaluated at various skeletal sites (vertebra and femur), and bone tissue micro-architecture was evaluated by static histomorphometry at the tibio-fibular junction (cortical bone) and at the tibia metaphysis (trabecular bone). Plasma total alkaline phosphatase (ALP) activity and serum levels of insulin-like growth factor-I (IGF-I) were also assessed.


In female rats treated with strontium ranelate over 2 years, dose-dependent increases of bone strength and bone mass of the vertebral body (containing a large proportion of trabecular bone) and of the midshaft femur (containing mainly cortical bone) were detected without change in bone stiffness. Similar effects were observed in males at the level of the vertebra. This increase in mechanical properties was associated with improvements of the micro-architecture as assessed by increases of trabecular and cortical bone volumes and trabecular number and thickness. Finally, plasma total ALP activity and IGF-I were also increased in treated animals, compatible with a bone-forming activity of strontium ranelate.


A long-term treatment with strontium ranelate in intact rats is very safe for bone and improves bone resistance by increasing bone mass and improving architecture while maintaining bone stiffness.

PMID: 15537445


Hi Lara,
It is great that you have improved your bone density without synthetic drugs. I am gong to try the same approach now. I think you said the strontium you have taken in recent times was a big help. I am wondering with all your knowledge was there some reason you did not commence taking strontium much earlier than you did?
regards, Eliza

Lara Pizzorno

Hi Eliza,
I began taking strontium citrate about 4 years ago after reading the research — my typical approach. Actually, Dr. Wright introduced me to strontium — he writes a newsletter called Nutrition and Healing, and devoted most of an issue to strontium about 4 years ago now. Yes, I believe strontium citrate is helpful — IF taken as part of the full nutrient, diet and exercise program I lay out in Your Bones (no one nutrient can do the job all by itself), taken apart from when calcium is consumed (calcium and strontium compete for absorption and calcium will always win, so best to take strontium at a separate time), and taken in amounts no more than 50% that of calcium consumed.


I am currently taking AlgaeCal and Strontium and have added Seriphos (Phosphorylated Serine Adaptogen and Adrenal Support) 2 capsules 1000mg daily and was wondering if there would be any negative interactions between the two. I take the Strontium just before bed time and I also want to take the Seriphos shortly after the Strontium or at the same time. This is the only time I can take these as to not interfere with my other medication (Thyroid) and supplements that I take.
Thanks for your input.

Lara Pizzorno

Hi Joanne,
No problem! Your adrenal support supplement will help you better utilize your AlgaeCal Plus and Strontium Boost. Taking a good adrenal support product is a great idea these days. Our chronically maxed out lifestyle is very hard on our adrenals, and without good adrenal function, lots can go awry, including a number of physiological effects that promote bone loss, e.g., progesterone gets used up to make more cortisol, so much less is available for osteoblast production and activation. Stress also causes us to lose magnesium, so our needs for magnesium, a critical component of bone, increase.
Re your thyroid meds (levothyroxine?), PLEASE be sure your doctor is running labs regularly to check that your dosage remains correct for you. Too high a dose will put you in a state of hyperthyroid activity — which promotes bone loss. Too low a dose, will result in hypothyroid function — which also promotes bone loss. I discuss the testing needed and the issues re thyroid in 2nd ed of Your Bones pages 321 and following. Also, you may want to try to figure out WHY you need thyroid medication — a number of factors cause thyroid dysfunction that are correctable with dietary changes and nutrient supplementation. Too much to summarize here, but discussed in the book.


Thanks for your reply to my question. I will have my doctor continue to check my thyroid medication. I do wish I did not have to take it. I will look into reading your book. Glad to learn that there will not be any interaction between Adrenal and Strontium if taken at the same time.

Lara Pizzorno

Hi Joanne,
You’re welcome! Levothyroxine, taken at the right dose for you, will be good for your bones — and the rest of you. Most of us, as we age, experience a lessening in thyroid hormone production and/or activity. Fortunately, we can provide our bodies with some assistance in restoring optimal thyroid function. Levothyroxine is an inexpensive drug, and the testing to check if dosage is correct is easy and inexpensive. In 2nd edition of Your Bones. I discuss at some length the nutritional factors our bodies require if we are to be able to produce our own thyroid hormones. Insufficient iodine and selenium in our diet is a significant contributing factor to low thyroid function as these nutrients are required by the body to produce thyroid hormones. For a number of reasons, which I discuss at length in a two part medical journal review paper I wrote for Longevity Medicine Review (this journal is written for a physician audience, but is free access so you can check out the article yourself if you are interested at and, many of us are not getting adequate iodine. I do hope you will read the 2nd ed Your Bones as it contains much information that will be helpful to you, and I believe it should be available at your library if you do not wish to purchase a copy. As it is published by a non-profit, cost is less than $10. Be well!


Hi Lara:
I will be having a DEXA scan next month to determine if the strontium citrate and algae cal plus that I presently take have been effective in increasing my bone density. Presently I take 680 mg stontium citrate daily and 2 algae cal plus twice daily.
Assuming that I have improved, what is the suggested dosage for each of these nutrients? Should strontium citrate be taken indefinitely?

Lara Pizzorno

Hi Shaine,
Once you are in osteopenic range, you can cut your dose of strontium in half. I’m barely osteopenic now, but continue to take 340 mg of strontium most days (I sometimes forget as I take mine with lunch, or I realize that I just ate a cup of yogurt — so the calcium, which competes with strontium for absorption and will always win out over strontium, most likely blocked much benefit from the strontium that day). Strontium is a very helpful mineral — it lessens osteoclast activity AND boosts osteoblast activity, so I will continue to take some even after I am no longer even osteopenic, which I expect to happen within a year or two at most. I may drop down to 1/4 the dosage though. Re AlgaeCal Plus — your bones, which are continually remodeling throughout your life, will always need the calcium, magnesium, boron, K2, D3 and trace minerals this supplement provides. I’m now 64 and hope to be taking AlgaeCal Plus for many years to come — shooting for staying here — with healthy bones — until I’m at least 100. Hope your DXA results are stellar — keep me posted, Lara


Thanks for responding so quickly regarding dosage for strontium citrate and Algae Cal Plus once I achieve good DEXA results. I do plan on continuing the algae cal plus but question if I need 4 capsules each day or if I can cut the dosage. I am not a milk drinker and eat limited dairy products so I am unsure of the additional amount of calcium that I am consuming during the day. Yes, do have fruits and vegetables daily, flax seed and chia seed (when I remember) and a relatively healthy diet. But, once again, I have no idea of the amount of additional calcium that is entering my body. (I have a copy of your last book and have read it from cover to cover.)
Many thanks again to you for your continued research. Let me know about the algae cal. To all our good health…

Lara Pizzorno

Hi Shane,
The best way for you to determine how much supplemental calcium (magnesium, boron, etc) YOU require, is to keep the food diary I suggest in Your Bones for 5-7 days and then use the charts in the book to see how much calcium, etc. YOU are typically getting from your diet. Once you know this, subtract this amount from 1,500 mg (if you are postmenopausal and not on bio-identical hormone replacement) or 1,200 if you are pre-menopause or postmenopausal and on BHRT. This is how much calcium YOU need to get from supplements. I realize keeping the food diary is a bit of a nuisance, but this is the only way to see what YOU actually need, so it truly is well worth the effort — and you only have to do it once unless your eating habits change dramatically. Most of us eat the same foods over and over and do not vary what we eat all that much. Also, keeping the food diary will let you see whether your diet (and your bones as a result of it) could benefit from a wee bit of dietary tweaking.
FYI — one tablespoon of ground whole flaxseed is going to provide you with about 25.5 milligrams of calcium. One ounce of chia seeds — about 3 tablespoons — will give you 176.68 milligrams of calcium. I did not put flaxseed or chia on my chart in Your Bones b/c these are not as commonly eaten, but I obviously should have done so! I did include the top commonly eaten sources of calcium — you’ll see that many vegetables are good sources of calcium, especially leafy greens, broccoli, etc., as are sesame seeds and tofu. Bottom line — you can get plenty of calcium cow-free! One important consideration regarding AlgaeCal is that it is supplying calcium within the naturally absorbed matrix of all the other trace minerals the sea algae used to create its bony structure — if you look at Appendix B in which I summarized all the vitamins and minerals healthy bones require, you will see that MANY trace minerals play important roles in our bones. If you find that your diet is supplying you with a fair amount of calcium, I would still consider taking at least some AlgaeCal as it will provide you with insurance that you are receiving these trace minerals in amounts in which they work together naturally. Bottom line here — truly worth keeping a food diary to see how much calcium your diet is giving you.


Hello again Lara:
In addition to reading your blog I also read a blog from an osteoporosis site. One person wrote in regarding strontium. This individual had a strontium/serum/plasma/urine blood test administered. Normal results from this test range from 10.0 – 45.0 ng/ml. This individual had results that were slightly under 2,000 ng/ml which, in her assessment, is over 4,000 % higher than the upper normal limit of 45.0 ng/ml.
Is this a test that those of us taking strontium citrate should request of our doctors? Is a high blood level dangerous?
Please comment about this particular test and what we should be aware of with the results.


I attempted to send this email last evening but I don’t think it sent.
An individual on the osteoporosis Inspire site wrote about elevated blood serum levels due to her consumption of the supplement strontium. She had test results from a strontium/serum/plasma/urine test that far exceeded the normal ranges. Normal range per her information is 10.0 to 45.0 ng/ml. Her range was almost 2,000 ng/ml ( which she indicated was over 4,000 higher than normal).
Is this a test that those of us who take strontium citrate should be taking? Should we be cautious of test results and monitor the amount of strontium citrate in our systems. Are high levels indeed toxic?
PLEASE comment about this. Many of us do take strontium citrate and do rely on much of the information that you provide.
Thanks, Shaine

Lara Pizzorno

Hi Shaine,
A number of people contacted me about this discussion group on the NOF. I sent the following reply to one of them to share there:

I found the discussion and have been looking – and looking and looking – for any research showing strontium citrate is toxic. I could find nothing. Only beneficial effects for strontium citrate. And as I wrote in my post on strontium that is still up on AlgaeCal’s website, no research conducted over the last hundred years shows any toxicity from strontium citrate – IF more calcium (I and Dr. Wright and many others recommend twice as much calcium to be on the extremely safe side) is being consumed. Outside of 2 studies conducted more than 50 years ago in which WAY more strontium was consumed along with virtually no calcium and ricket-like bone malformations occurred, the only adverse health effects noted in the peer reviewed medical literature with strontium are seen the patented drug version, strontium ranelate, which significantly increases risk for VTE and DRESS syndrome plus a number of other unpleasant but less deadly effects. My apologies, but I don’t have time right now to repeat the full discussion, but it and all the references can be found on AlgaeCal’s blog.

This being said — we must ALWAYS trust our own bodies when our personal results don’t match up with the research – no matter how “august” and “respected” the medical journals or how many studies have been published showing something that our own unique body is not agreeing with! I cannot emphasize this enough. We are each UNIQUE. I think arrowsp’s suggestion that for SCW strontium absorption may take more time than is “average” so abnormally high levels might have still been present in her blood when the test was run is certainly worth considering.

Some other things SCW might consider and discuss with her doctor:

I am wondering, “how much calcium is SCW taking?” If she is consuming 680 mg elemental strontium daily, then she should be getting at least twice that amount (1360 mg) of calcium each day from her diet and supplements.

Were her blood calcium levels also measured? Is she able to absorb calcium effectively? Or is there some issue with her ability to absorb calcium as well? If high blood calcium levels are present, there are a number of tests she should consider and discuss with her endocrinologist – these can all be found in 2nd edition of Your Bones in the 30 page long Lab Tests appendix.

How much vitamin D3 (I hope she takes D3 as it is significantly more effective for us than D2) is she taking? What are her vitamin D levels — her (25(OH)D blood levels? Optimal is 60-80 ng/mL; the 30 ng/mL level, which many docs still refer to as just dandy, is barely above frank deficiency.

Calcium and strontium compete for absorption and calcium will always win, which is why it is recommended that strontium supplements be taken apart from when calcium is consumed. If SCW took calcium (or ate foods rich in calcium) when she took her strontium, the calcium would have prevented strontium’s absorption.

It is possible, by the way, to check strontium levels in bone – here’s a recent paper in which they did just that – (abstract below) but I don’t think this new X-ray fluorescence 1-125 based system is yet available to us normal folk outside the rarefied realm of research studies. I will be looking for it as this would be a very useful test for those of us taking strontium.

This study was done to see how much strontium this osteoporotic woman’s bones were absorbing from a strontium citrate supplement (680 mg elemental strontium per day) and whether the beneficial effect continued after 800 days– it did.

Bone. 2012 Jul;51(1):93-7. doi: 10.1016/j.bone.2012.04.008. Epub 2012 Apr 23.

Monitoring bone strontium levels of an osteoporotic subject due to self-administration of strontium citrate with a novel diagnostic tool, in vivo XRF: a case study.

Moise H, Adachi JD, Chettle DR, Pejović-Milić A.


Department of Physics, Ryerson University, Toronto, Canada.

A previously developed in vivo X-ray fluorescence (IVXRF) I-125 based system was used to measure bone strontium levels non-invasively in an osteoporotic female volunteer. The volunteer was recruited in December 2008, as part of the Ryerson and McMaster University Strontium in Bone Research Study and measured at twice weekly, weekly and monthly intervals. Thirty minute measurements were taken at the finger and ankle bone sites, representing primarily cortical and trabecular bone, respectively and the strontium K-alpha X-ray peak at 14.16 keV was used in the analysis. Since the volunteer had no prior history of strontium based medications or supplementation, baseline natural strontium levels were obtained followed by a 24h measurement of first intake of strontium citrate supplements (680 mg Sr/day). While the baseline levels of 0.38 ± 0.05 and 0.39 ± 0.10 for the finger and ankle, respectively, were on par with those previously reported in Caucasians among twenty-two healthy non-supplementing strontium individuals by our group, an increase began to be seen after 24 hrs of 0.62 ± 0.14 and 0.45 ± 0.12 for the finger and ankle, respectively. By 120 h, the increase was statistically significant at 0.68 ± 0.07 and 0.93 ± 0.05, respectively. Further increases occurred within an interval of 90-180 days, with the most recent, after 800 days, at the finger and ankle being 7 and 15 times higher than the initial baseline reading. The intriguing results show bone strontium incorporation and retention follow a pattern, suggesting strontium levels, at least in the ankle, do not plateau within two to three years and will continue to increase over time, as an individual takes strontium supplements. The ability of this IVXRF system to monitor and measure bone strontium levels over time provides a useful diagnostic tool to help gain insight into strontium bone kinetics.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID: 22549020

Be well, Lara

John McDonald

Hi Lara

Many thanks once again for all your answers to the questions on this blog and also for the

wealth of information in your books. I have a question re. the time interval between the

servings of Calcium. It feels more comfortable for digestive purposes to take the Strontium

with other food rather than, for example, late at night before lying down in bed. Also

breakfast time seems to be the meal which is most easily controlled for Calcium intake and

therefore Strontium is taken at this time. The first serving of the Calcium supplement is then taken

around lunchtime which also includes dietary Calcium and then the second serving some six

hours later at evening meal which again includes dietary Calcium. I wonder if the interval

between Calcium intakes is too short. Should the Calcium supplement be taken morning then

evening for better absorption or is the schedule of Strontium – Calcium – Calcium, with the

three meals of the day, equally effective. Your advice would be much appreciated.

John M


Dear Lara, I have been reading your comments to people about Algae Cal. I have been taking 3 Strontium in the morning, waiting one or two hours, then after eating breakfast, I am taking 2 Algae Cal, along with other supplements and herbs. I then take 2 more Algae Cal with dinner and the other supplements and herbs. I found out at 49 that I had some bone loss. Until about age 55 I tried to control it with diet and exercise. I have been a huge exerciser since about age 30. I have done nine varies classes this week at the gym. I am now 65. Then at age 55 the GYN thought I should go on Actonel. After taking it for about seven years, I went for my GYN appointment. The PA asked me how long I had been on the drug. She proceeds to tell me that research had found that after taking the drug for a 10 year period, it could make the bones brittle. So in the spring of 2010, I stopped the Actonel. I tried a calcium from the herb store but in 2012 had another bone scan. I had not gotten any better, in fact my scores had dropped. So I got on the internet and came across the Strontium and Algae Call site. I talked with my Acupuncturist about it and he said if he were to prescribe anything, one thing would be the Strontium. So I have been taking it for one year faithfully. Since turning 65 and having Medicare now, I was able to have another DEXA scan sooner then the two or three year period that is recommended. I will give you my scores from 2012 and 2013. Pa Lumbar Spine L1 through L4: BMD: .805 g/cm2, T-score -2.2, Left Femoral Neck: BMD: .716g/cm2, T-score: -`1.2, Left Total Hip: BMD: .958 g/cm2, T-score: .1——– This year in 2013 my scores were—PA Lumbar Spine L1 – L4: BMD: 0.846 g/cm2, T-score: -1.8, Left Femoral Neck: BMD: 0.767 g/cm2, T-score: 1.7, Left Total Hip: BMD: 0.965 g/cm2, T-score: 0.2. As you can see the Lumbar Spine is a bit better, but the Left Femoral Neck and Left Total Hip is worse. How can that be. I would think that it should be an all over better score. I did read that the DEXA scan does not calculate correctly when a person takes Strontium. So I wonder if it is really better in the Lumbar?
Also, I had cancer 9 years ago. The cancer dr. had my vitamin D 25 Hydroxy tested. She says that vitamin D3 is a great help with breast cancer patients. The test was done a year ago and came back at 44.2 So it was in the right range. I was taking anywhere from 3 to 5 thousand IU a day. Now I only take what is in the four capsules of Algae Cal which ends up to be around 1600 IU, and about every other day I take 2,000 IU in a supplement. Also the calcium from Algae Cal is 720 mg. in four capsules. Is that enough. I know that we have other ingredients in the Algae Cal. But I know that I am to be taking around 1500 mg. of calcium a day. But I realize that Algae Cal is different. I figure that the people making it know how much a person should take.
My questions are, why are not all three areas better in the Dexa scan, since the Lumbar is better. Should I continue with Strontium and Algae Cal, maybe take more of each. Also, from having breast cancer nine years ago I can’t take estrogen or progesterone because my tumor was positive to both. I did have 37 treatments of radiation. My GYN wanted me to take Avista last year, but I choose not to take drugs. She also wanted me, at one point to take a shot of something everyday. The side effects of it were bone cancer. My father died at age 90 of Leukemia and bone cancer, so I told her absolutely not. I am really not sure what to do next. I was in hopes that from the rave reviews on the Algae Cal that I would have had higher scores on my Dexa scan. Apparently, I don’t absorb the calcium very well. I hope I have made this e-mail clear enough and given you enough information so you can get the feel for my situation.
I would appreciate any comments or suggestions you might have for me. Thank you for your time and listening, Eilean

Lara Pizzorno

Hi Ellean,
I so hope you get this reply! I just received your questions — AlgaeCal’s blog has been undergoing an overhaul, and I have been in and out of town for the last 2 months because of attending a number of medical conferences — from Tempe, Arizona to Banff (Canada) to Dallas, TX. In addition, my computer died just before I left for AZ, so I was reduced to just my iPhone for several weeks. The end result is that I am just now receiving a number of queries I would ordinarily have received months ago. Please accept my apologies for not replying to you sooner!

In response to your questions re your DXA scores — do you know what type of DXA machine was used for these 2 scans? If it was not the same type of machine, the scores can vary. Also, if the lab tech evaluating your DXA did not take the reading from precisely the same place as your earlier DXA, this could affect your scores. And it is also true that – as I explain in full in the blog to which you replied — strontium results in artificially inflated scores — but this does not mean that the strontium has not improved both the density and more importantly the quality of your bones; it just means that the scores are higher in part because of the size of the strontium molecule. Keep taking your strontium citrate! Just be sure, as I explain in the blog, that you are getting twice as much calcium as strontium.

AlgaeCal supplies 720 mg of calcium because, for virtually all of us, our diet supplies at least 400 mg of calcium each day, and for many people, 1200 mg of calcium is what is suggested. If you have a copy of Your Bones (either the 1st or 2nd edition), you will find a listing of all the commonly eaten food sources of calcium and how much a typical serving supplies. You need to keep a food diary for 4-5 days and then figure out how much calcium YOUR diet is typically providing for YOU. Then you can determine how much additional calcium you need from supplements to reach 1,500 mg/day. Ditto for all the other vitamins and minerals our bones require — you can use the same food diary to figure out what your diet is supplying and thus how much YOU need to supplement. Information about amounts of each nutrient in commonly eaten foods is provided in Your Bones to help you do this and see what YOU, not some imaginary person, truly need from supplements.

A 25(OH)D level of 44.2 is NOT optimal. The Vitamin D Council recommends 60-80 ng/mL as the optimal level of circulating vitamin D.
Also, even if your blood levels of vitamin D are good, and you are getting a total of 1,500 mg of calcium each day from diet and supplements, if your levels of vitamin K2 are not also good, you are likely to be depositing the calcium you are absorbing into your arteries, kidneys, breasts and brain rather than your bones. Vitamin K2 is responsible for activating the proteins that put calcium into bone (osteocalcin) and keep it OUT of arteries, etc. (Matrix Gla Protein). You need at least 120 mcg (180 mcg was shown in the most recent study published on K2 use to build bone in women with postmenopausal osteoporosis) to activate these proteins and put your calcium where you want it. Vitamin K2 cannot be consumed in the diet at these amounts — unless you are regularly eating natto (a fermented soybean product commonly eaten in Japan and a major reason why osteoporosis is much less common there). A single serving of natto delivers more than 400 mcg of K2 (K-7)! Unfortunately, natto smells like sweaty gym socks and has a slimy texture most of us in the West do not enjoy. Fortunately, we can get our MK-7, derived from natto, easily and inexpensively in pill form.

As you have already figured out, the drugs are NOT your best option for healthy bones. Actonel, the bisphosphonate you were prescribed and took for 7 years prevented normal bone remodeling for you and gave you brittle bones. Forteo is the drug that you refused — this is given by daily injection and abnormally spikes parathyroid hormone levels. In a separate blog on AlgaeCal’s website — and in more detail in the 2nd edition of Your Bones — I have explained why this is not a good idea! In sum, the most concerning potential adverse effects are osteosarcoma and an increase in cortisol levels, which causes bone loss.

My guess is that — if your digestion is excellent and you are absorbing your nutrients well — you need more vitamin D3 plus K2 (MK-7). Your diet may also not be optimal for YOU. At the medical conference I just attended in Dallas, TX (the IFM International Symposium — more than 1,200 docs from all around the world — it was spectacular) the most significant new research reported was by Fasano and focused on why we are seeing such an increase in problems related to wheat consumption. It turns out that modern (AKA “franken-“) wheat, which has been hybridized to produce much higher levels of gluten, causes the lining of our intestine to open up for at least several hours in EVERYONE and permanently in those who develop celiac disease. Thus modern wheat is extremely pro-inflammatory and is a significant contributing factor to MANY diseases, including osteoporosis. You might try going gluten-free. My family went off gluten about a year ago and each of us has noted a variety of improvements in our energy, digestion and overall health. A great resource for this is the website, Living Without. They also publish a magazine. If you sign up there, you will be able to read their earlier magazine entries — in the August/September issue 2011 they interviewed Fasano and the article provides a good overview of the health issues caused by modern day wheat.

Lara Pizzorno

Hi Ellean,
I’m on the road for two medical conferences — one in AZ where we are now, then another in Banff, AND my computer crashed right before we left, so I am reduced to using my iPhone (and my husband, Dr. Joe Pizzorno’s computer when he is taking a quick break) SO if I cannot reply quickly, please accept my apologies. I will be back home and will have a new computer by May 10th, so things will return to “normal” by then. Meantime, I have Joe’s computer for a few moments, so here are my initial thoughts for you.
In sum – it’s great that you are seeing some improvement, and both AlgaeCal Plus and Strontium Boost should be helping you, but if you are not rebuilding successfully everywhere, you are either still being exposed to something that is causing your bones to lose mass more quickly than they can rebuild OR you are not getting enough of something your bones need to do so. OR your DXA was run on a different type of equipment than your last DXA so the readings are off — the different machines do not work precisely the same, so this is also a possibility.
A vitamin D (25(OH)D) blood level of 44.2 is not great. IF the measure used was ng/mL it is below optimal which is 60-80 ng/mL. IF the measure used was nmol/L, then 44.2 is very low as the optimal range for nmol/L is 150-200 nmol/L.
Vitamin D3 and calcium are NOT the only nutrients required for healthy bone remodeling. Vitamin K2 (preferably MK-7 form at a dose of at least 100 mcg/day) is also essential, as are magnesium, vitamin C, boron, B vitamins and numerous trace minerals. Calcium, D3 and K2 work together. D3 increases your body’s ability to absorb calcium but does NOTHING to determine where that calcium goes; this is the job of K2, which activates osteocalcin (the protein that pulls calcium into bone) and matrix Gla protein (which keeps calcium OUT of arteries, breasts, kidneys, brain). IF you are taking AlgaeCal Plus, then you are getting K2 (MK-7) along with D3 and calcium (and magnesium, boron and some vit C, and a number of trace minerals), but YOUR body may require more vitamin D3 and K2 than AlgaeCal Plus provides. This is the case for me — I need a LOT more vitamin D than the “average person” b/c of my genetic inheritance — my vitamin D receptors don’t work all that well, so I need more to do the job for me, which means I also need more K2 since these two nutrients team up with calcium. YOU are also unique, so may need more of some nutrient.
Yes, we (postmenopausal women) all need more than 720 mg of calcium daily — and should be getting this from our diet. In Your Bones, 2nd edition, I provide a listing of all the commonly eaten foods rich in calcium, along with how much they contain in a normal serving, so you can keep a food diary for 4-5 days and see what you are typically getting from your diet. I also do this for all the other nutrients your bones need, so you can determine what you are getting and how much you need to get from supplements. You need to look at the WHOLE picture, not just one nutrient. The health of YOUR bones is a nutrient team effort.
You mention that you may not be absorbing the calcium you are taking– WHY do you think so? Do you have digestive issues? Are you taking any other drugs that might interfere with your stomach’s ability to produce the hydrochloric acid required for you to make calcium absorb-able? Do you take Tums or acid-blocker meds like Nexium? Or some other drug with side effects that could affect your bones’ health?
I suggest you get your vitamin D levels checked again. Also, if you do have digestive issues, if you can tell me more about them I can give you some suggestions. One right away is to read a book by Dr. Jonathan Wright, MD, titled, Why Stomach Acid is Good for You. MANY of us over age 50 are deficient in stomach acid, and the symptoms produced are the same as if we had too much stomach acid, so we take acid blockers and make the problem worse. You cannot do a good job of freeing nutrients from your food if you are not producing sufficient stomach acid. Another potential factor is gluten intolerance — the latest studies are showing that at least 10% of us are reacting to gluten in wheat, which damages our stomachs and intestines and causes a chronic low grade inflammation that promotes bone loss. These are a few of the things that your note to me brings up to my mind right away — there are MANY other factors as well. In 2nd ed of Your Bones, I added a 30 page Labs Appendix discussing all the labs that you might consider having run to help you determine why you are still losing bone if you are doing everything suggested in Your Bones and are not rebuilding. Obviously, I cannot discuss them all here, but I hope you will get a copy of the book and read up — I believe it will be available in your library if you don’t want to buy one. The first edition was approved for our library system, so I am sure the 2nd one will also be. The book is on Amazon for less than $10 as it is published by a non-profit. AND I am happy to try to help you here — send me any further questions you have and I will do my best to help you — but I may not be able to reply right away as I am attending medical conferences over the next 10 days and am without my computer.


Thank you Lara for the lovely e-mail. When I wrote to you this evening, I really wasn’t sure if anyone would actually get back to me.
The DEXA scan machine was a new one. It was still at the Bronson Women’s Center in Kalamazoo, Mi. but was different then last year.
On my lab report for the Vitamin D, it was measured in ng/mL units. The Expected Range was 30.0 – 100.0. So by that, they told me that it was fine. I had no idea that it might not be right.
As far as me not absorbing the calcium, I have to say, I don’t know that for a fact, I guess I just assumed that I wasn’t because of the Dexa not being up in the scores. I guess I figured that the calcium was going to the bones and didn’t realize that it could be going other places. I did have my urine check several years ago to see if I was excreting the calcium out, but I wasn’t.
The only drugs that I take are Inderal 80mg. LA. I take one at bed for a Mitro Valve Prolapse. It was discovered at age 47. Then I also take 20 mg. of Elavil which keeps me somewhat calm. I tend to be a nervous type. Type A personality, perfectionist. To me that is not a good thing. It makes life difficult.
I don’t take acid blockers. I have on occasion taken a few sips of an Alka Seltzer. But in the last year if I would need anything like that, I have an Herb from “Now” products which works wonderful. I mostly will feel something in my throat if I don’t take my supplements early enough in the evening and then lay down for bed. I use to get stomach aches, and would bloat once in a while if I over indulged. I am now taking a plant derived Digestive Enzyme HP 90V. I also take L. Acidophilus. I go to an Herb store where the women that owns the store does muscle testing. I was showing evidence that I needed these supplements.
I do have fungus in my toe nails, which I am finding that it is an inflammation, which can be linked to raising cholesterol. Do I have the right? I have a higher cholesterol, but about a year ago my triglycerides went up and I started on some herbs for both, which have been working. I am fussy with my diet. I do eat salmon, I try to get wild caught but not very successful with that, we also eat chicken, turkey, some pork, and sometimes deer when we have it. I have also just learned that meat can cause inflammation. I am learning little bits here and there, it sounds like lots of things can cause inflammation, and that can stop the absorption of calcium and it is almost over whelming to me. I don’t know exactly what to do.
The gluten I know has been a big issue recently in the health news. I pretty much don’t eat any breads but Ezekiel. The sprouted 100% whole grain. Maybe once a week I have toast out of it. I do eat oatmeal, usually whole grained or steel cut and organic if I can get it. . Always a salad for lunch based with spinach and romaine lettuce. We eat a lot of veggies and some fruit. I am a person to by organic if I can possibly get it. I even by meat when I can that does not have antibiotics or hormones in it. My cancer surgeon told me not to use or try not to eat food with hormones in it.
Two years ago, when I told you about stopping the Actonel, one of the symptoms was dental problems. We have had a lot of stress in the last ten years or so. I had some teeth that cracked. I have always had really good teeth. Nothing ever wrong with them. I ended up having to have a cracked tooth out that the dentist tried to fix, it got infected and had to be pulled. I then had to wear an appliance at night to keep from gritting my teeth. Not grinding, but gritting my teeth like, as the dentist said, a vise grip. The cracking of teeth, the dentist said he had seen in patients taking the Bisphosphonates.
I will look into the Book “Why Stomach Acid Is Good for You.” Also your 2nd addition of “Your Bones” on Amazon. I’m sorry to be all over with what I am writing. I just have so many things I am thinking about, and somehow I think they all tie together. I think a lot of it is heredity.
So taking extra D3 sounds like it is alright, but at some point I need to get some more blood work done. Do you recommend taking more of the Algae Cal or should I monitor my intake of calcium in my food first?
Thank you for answering back. I realize that you are very busy right now with the conferences, but will look forward to your comments when you are available. Thanks again, it is much appreciated, Eilean

Betsy Wilson

Hello Lara,

I am trying to decide on a supplement to take. You recommend AlgaeCal Plus and Strontium Booster. My question is if I am eating approx 800-1000 mg of dietary calcium per day now, Should I reduce dairy calcium when on this supplement? My dr has recommended that I stop calcium supplements because my diet is high in calcium. I have osteoporosis in spine, openia in hips, had been on Fosomax 4 years… it increased BMD first 2 years then no, some decrease in BMD. No fractures. 59 years old. no other meds. My blood and 24 hr unrine tests all normal I exercise, no smoke, very little alcohol, healthy eating habits., btw my dr. wants me to go on forteo…. not in agreement with this based on your book and other reading. thanks for your input.

Lara Pizzorno

Hi Betsy,
I sure hope you get notified and see my response. My apologies it has taken so long. AlgaeCal has been improving their website, and I have been traveling to a number of medical conferences over the last two months. Plus, my computer died right before I left for conferences in Arizona and Banff, so for several weeks, I was reduced to just my iPhone. The combination of all of this resulted in a number of questions not getting to me.
It’s hard to reply to your question without more information. What foods are you eating regularly that are providing you with 800-1,000 mg/day of dietary calcium? Are you eating leafy greens? Dairy products? if so, what kinds of cheeses? any yogurt? cow’s milk? goat milk? sheep milk products? Soy foods with added calcium? Sardines (and their bones)? How good is your digestion? What are your vitamin D levels? If your vitamin D is very low, then you will be unable to effectively absorb calcium from your diet (or supplements) even if your digestion is great. If your digestion is not good, you are going to have trouble breaking down the foods you eat and releasing their nutrients for absorption. And even if your digestion is good and your vitamin D levels are as well (specifically your blood levels of 25(OH)D are in the 60-80 ng/mL (optimal) range), if you are not getting adequate vitamin K2 (the latest research indicates at least 180 mcg of the MK-7 form of K2 is required for postmenopausal women with osteoporosis), the calcium you absorb is likely to be depositing in your arteries rather than in your bones. Vitamin K2 is responsible for activating the proteins that put calcium into bone AND keep it OUT of arteries, kidneys, breasts and our brains.
IF you have read the 2nd edition of Your Bones or my blogs, you know why Forteo is not the best answer for healthy bones — this drug artificially spikes parathyroid hormone levels and also causes cortisol levels to rise (which causes bone loss); plus 45% of the rats in the animal studies developed a very aggressive form of osteosarcoma (bone cancer). I hope you will write back to me with more information, so I can give you a more precise reply. In sum, from what you have shared, IF your digestion is excellent, I recommend you check your diet to see if, in addition to calcium, it is also supplying you with 3 mg of boron, at least 1,000 mg of vitamin C, and 500 mg of magnesium citrate daily. You will need to take a vitamin K2 (MK-7 supplement providing you with at least 120 mcg per day (as I noted, the latest research on postmenopausal women with osteoporosis got best results using 180 mcg of K2 [MK-7] per day for rebuilding bone) and at least 2,000 IU of vitamin D3. If you decide to supplement with AlgaeCal Plus, much of this will already be supplied for you. And Strontium citrate (supplied by Strontium Boost) has been shown in many studies to effectively and safely rebuild bone; you cannot consume the amounts of strontium citrate required from your diet, so I would recommend you consider taking Strontium Boost at the full dosage until you are well back into only the osteopenic range. You should get your vitamin D blood levels checked to see if you require more vitamin D3 than is provided by AlgaeCal Plus. You should also consider taking additional K2 (MK-7). If you do not eat lots of leafy greens (4-5 cups daily at least), you should also be taking vitamin K1 as it is highly anti-inflammatory and thus helps prevent excessive bone loss. I could write a book here to fully answer your questions — and I have done so. Please check 2nd edition of Your Bones out of your library if you do not wish to own a copy. The answers to all your questions are fully discussed therein. I hope this –albeit delayed — reply gives you some places to start. And very much hope you will keep me posted. BE WELL, Lara


Hi Lara:
I recently had a DEXA scan which showed some improvement in my bone density. This test was measured against a Dexa Scan from 2011 when I had also been taking strontium citrate. I am still, however, in the osteopenia range (but at 85%-89% of normal). I I have been using algae cal for about 8 months and I also use Drs. Best Strontium Citrate. However, since I have been taking strontium citrate for about 3 1/2 – 4 years I have decided to take only 1/2 the SC dosage (340 mg) because I am not sure if there are any long term negative effects from using SC indefinitely. I would like to hear your opinion regarding how long you feel one can take Strontium Citrate.
In addition, rather than take the full 4 tablets of algae cal, I am increasing my calcium consumption from food and plan on reducing the algae cal to 3 tablets daily. What is you opinion of this?
Looking forward to your response.

Lara Pizzorno

Hi Shaine,
Wonderful that your bone density is improving! A number of medical experts now recommend that, once bone density has moved out of osteoporotic and into osteopenic range (which you now are), the dose of strontium citrate can be cut in half. I agree with you that long-term use of strontium citrate at the full dosage may not be optimal, and why risk it? You are supporting your bone health by taking AlgaeCal Plus along with ensuring your diet is providing adequate calcium — from healthful, organic whole foods, such as leafy greens, organic dairy products from grass-fed cows, organic GMO-free soyfoods — correct? If so, then I think your plan is excellent. Stay well, Lara

Dipti Buck

Hi Lara,

So encouraging to read all your messages!!
I have ordered Algae cal with Strontium citrate
and wanted to know if it would be good to take
these with Eltroxin 25 which I’m taking for my
Thank you!

Dipti Buck

Hi Lara,

Just wanted to know if I can start Algae cal with Strontium along with eltroxin25.

Lara Pizzorno

Hi Dipti,
Sorry for not responding earlier — I have been at several medical conferences over the last few weeks, just catching up now.
Eltroxin25 is one of the trade names under which levothyroxine (synthetic T4 thyroid hormone) is sold. It’s just fine to take AlgaeCal Plus and Strontium Boost along with levothyroxine. It is, however, very important to (1) take Strontium Boost at a different time of day from when you take AlgaeCal Plus or are consuming foods rich in calcium. Strontium and calcium compete for absorption, and calcium will always win, so you will get much less benefit from the strontium if taken at the same time as calcium. (2) Be sure you are consuming at least twice as much calcium as strontium. If you are taking the full 4 capsule dose of AlgaeCal Plus, you will be automatically be getting twice as much calcium as strontium. (2) ensure that the dose of levothyroxine you are taking is “just right” for YOU. If the dose is too low, you will still be hypothyroid. If the dose is too high, your thyroid function will be increased too much. Either situation — hypothyroid or hyperthyroid activity causes bone loss. Your doctor will know what tests need to be run to check that the dose you are taking is the dose YOU need. If you have a copy of the 2nd edition of Your Bones, you can check the Labs Appendix for a discussion of thyroid hormone tests, pp. 320 and following.

angie king

Hi Lara,
I am 41 and dx with osteoporosis of spine (-2.7) and Osteopenia of hips (-1.6) in Dec 2012. My Dr. placed me on Fosomax. I had a lot of reservations about taking the medication but he assured me we caught it early and would probably only need to be on it for 2 years. I am small frame and have a long family history of osteoporosis in every female family member. I have not reached menopause but had been taking continuous birth control pills for over 5 years. I have always been very active and I am a healthy eater. I have been making green smoothies for 4 years. I do not smoke, drink carbonated beverages, or drink alcohol in excess. My dr just said I was a “skinny white girl” and that was enough for this dx. I am devastated and scared to death. I insisted on the bone density test after a fx in my hand in Sept 2012. My Dr. told me to take any calcium supplement and recommended Oscal. He never recommended Magnesium but also had me on a D3 supplement that is 5000 IU. I was not deficient in vitamin D in my blood work. He did tell me to decrease my calcium intake to 500 mg a day when I went back to him in April.
Since starting Fosamax in Dec, I had a terrible cold and cough that I could not shake. My allergy tests came back negative and I began to wonder if it was the Fosamax keeping me sick so I stopped it a month ago.
I have on my own changed the calcium I take to calcium citriate and increased the dosage back up and added magnesium, strontium and MK-7.
I don’t want to be scared to do all the fun activities I have always done. I have a very physical job and now I am obsessed with injuring myself. I work as an activity director with Alzheimer’s patients so I understand the trauma of FX’s. The only other medical condition I have is HTN and was dx with that at age 33. I have been on Atenenol (not sure if that is spelled right) 25 mg 2x a day. My blood pressure runs 110/70 now. I also have ligament laxity so my podiatrist recommended I wear my tennis shoes with my orthotics for pilates and yoga. Not too comfortable to say the least and I got away from it.
Of course I now want to incorporate as many supplements into one as I feel like I take a ton of supplements throughout the day. I am interested in AlgaeCal but was concerned about the mercury that may be in those supplements. I just want to feel normal again and turn these scores around… quickly so I feel like I have my life back. Any advice would be greatly appreciated.

Lara Pizzorno

Hi Angie,
When you say you are not vitamin D deficient — what does this mean? What were your blood levels of 25(OH)D? Anything below 30 ng/mL is frankly deficient. Optimal is 60-80 ng/mL. If your doctor put you on 5,000 IU of D3 (I hope it was D3 and not D2 which is not nearly as effective), then your blood levels were not great. And you may need even more. Ask your doctor about running the Osteoporosis Panel offered by Genova Diagnostics — a number of genetic polymorphisms (SNPs) promote bone loss. I know all about these as I have one — my vitamin D receptor doesn’t work well, so I need at least 10,000 IU of D3 every day to get into decent range. Virtually all the SNPs that promote bone loss can be corrected for with adequate supplementation and avoidance of some triggering factors, but you must know which one(s) you have first. Since osteoporosis runs in your family, it is highly likely some bone-loss-promoting SNPs are present.
You mention magnesium but don’t say how much — you should be getting (from diet and supplements) at least half as much magnesium (hope it’s mag citrate, which is more easily absorbed) as calcium, and many experts now recommend equivalent amounts of these two minerals which balance one another in a plethora of key physiological activities. How is your digestion? Are you able to well digest the foods you eat and absorb nutrients well? High blood pressure suggests to me that your homocysteine levels may be elevated — and if so, you may require way more B12, B6 and folate than the “average” (mythical) person. Have you had your homosyteine levels checked? High homocysteine is extremely inflammatory and contributes to both cardiovascular disease and bone loss. If you have not already done so, please have your homocysteine levels checked. If they are elevated, you may wish to consider taking a B vitamin supplement that provides the activated forms of folate, B12 and B6 — many of us also have, as part of our genetic inheritance, a compromised ability to activate one or more of the B vitamins, and they only work well for us when in their activated forms.
How much MK-7 are you taking? If you find you need more D3 than average, you will also require more K2 (MK-7). In the latest studies on K2, they are using 180 mcg/day in women with postmenopausal osteoporosis and 360 mcg/day in patients with coronary artery disease. No UL has been set for K2 as it has not been found to produce adverse effects even at higher doses — even 360 mcg of MK-7 per day is not truly that high since more than this amount (425 mcg/day) can be, and is frequently, consumed by Japanese who regularly eat natto.
You may not be aware that oral contraceptives (birth control pills) work by inhibiting follicular development and preventing ovulation. Since progesterone is produced by the corpus luteum, which only forms after ovulation, not ovulating means virtually no progesterone will be produced and thus virtually no osteoblasts will develop. Osteoblasts are the specialized cells that build bone. Your birth control pills likely contributed to your current bone health problem.
It sounds like you are aware that Fosamax caused you to retain old brittle bone, and interfered with your ability to rebuild new healthy bone. Now that you have stopped taking it, your body should begin to once again remove old bone and build new bone. In some women, however, restarting this normal process can take up to a year.
Re AlgaeCal — I believe it is the best calcium supplement available because it delivers not just calcium, but calcium in the full matrix of trace minerals (many of which we now know have significant beneficial effects on building bone — I discuss all of them in 2nd ed of Your Bones) that the sea algae utilized to build its bony matrix. Personally, using AlgaeCal as my calcium supplement made a huge beneficial difference for me. FYI –I am NOT paid by AlgaeCal. I recommend it because I have read the research and personally experienced benefit. And I reply to questions here because it’s truly a mission in life for me to try to help others avoid or reverse osteoporosis. Like you, I come from a family in which all the women died earlier than they should have largely due to osteoporosis. I will be the first who doesn’t — and I have MANY genetic susceptibilities that promote my developing osteoporosis. I was well on my way to full blown osteoporosis in my mid-40s well before menopause. I am now almost 65 and have great bones. You can, too! If you have not read 2nd edition of Your Bones, please get a copy or check it out from your library and review all the potential contributing factors to bone loss that I discuss in the book. You are likely to also see other things you should check into besides the ones that came to mind for me when reading your comment. Eliminate the factors that are promoting YOUR bone loss and supply your bones with the nutrients required to rebuild, and they will do so. Hope this helps, Lara


Hi Lara,

Thank you so much for all the information and support you have given us! I just finished your book and it confirmed that what I have been doing for four years is indeed working. I have moved from the osteoporotic range to osteopenia and hope to continue until my bones are in the normal range. Thanks for your thorough research and thoughtful insights in writing Your Bones!

My question is this (and I apologize if it’s been asked before):
Some have said that strontium replaces calcium in the bones. I know that we take them separately so they won’t compete for absorption because calcium will win. But in taking them separately, does strontium replace calcium in the bones? I always thought it just added to the calcium and helped strengthen. If it does replace calcium, where does the 1200 mg of calcium go? K2 is supposed to direct it to the bones and teeth and not the arteries. If strontium is replacing calcium in the bones, where is it going?

This is a subtle distinction, but I’m wondering if people are misinterpreting the instruction to take strontium separately. Please clear this up and let us know whether taking the two minerals separately just allows both to remineralize bones, or causes strontium to replace the calcium in bones.

Thanks again for all you do, and especially your prompt and informative responses on this blog!

Lara Pizzorno

Hi Charlotte,

So delighted you have been helped by the information in Your Bones! YOU are the reason I wrote the book.

Actually, no one has asked whether strontium “replaces” calcium in our bones. A great question. You are correct that, taken in recommended amounts — no more than half as much strontium as calcium — strontium adds to the bone matrix and helps not only strengthen bone but improves bone quality and ability to resist fractures. If strontium is taken in excess of calcium, more strontium than calcium will be available in the body to be used in bone, so more strontium than calcium will be incorporated into the bones, and at least in baby rats, whose skeletons were rapidly developing and who were given no calcium and lots of strontium, ricket-like bone abnormalities developed. This is why you want to be sure to be consuming twice as much calcium (from diet and supplements combined) as strontium. Your bones are quite capable of using both the 1,500 mg of calcium AND 680 mg of elemental strontium recommended for daily intake for postmenopausal women not on bio-identical hormone replacement (I say only BHRT here as conventional HRT is a very bad idea for many reasons!)

Calcium and strontium should be taken separately because they compete for absorption — and calcium will always win, so your bones will get little benefit from the strontium you take if you are consuming it at the same time as calcium.

One other bit of information about calcium — this mineral plays MANY essential-to-life roles in our bodies besides its use in our bones and teeth. Calcium is critical for maintaining acid/alkaline balance (called pH) in the blood. When blood pH begins to drop too low (down to 7.35 from a baseline of 7.4), calcium is immediately withdrawn from our bones to restore proper pH in our blood — because proper pH is essential for numerous critical life functions, including processes as varied as breathing rate and the ability to transport oxygen throughout our bodies via red blood cells. Calcium is also required for our nerves and muscles (including our cardiac muscle, the heart) to function properly. Proper calcium balance inside and outside of nerve cells is required for sodium to flow in and out of these cells, and this flow of sodium is the way in which nerves conduct signals to and from the brain. When our nerves send a muscle cell a signal to fire, the muscle cell responds by allowing a flood of calcium to enter, and it is calcium’s entry into the muscle cell that initiates the cascade of reactions that result in making the muscle cell contract. In sum, calcium has plenty to do for us in addition to its use in maintaining healthy bones and teeth.

linda munnoch

Lara I’m a 60 year old woman from Scotland. I was diagnosed with osteoporosis 5 years ago. I was given a bisphosphonate, took one and it was like a bomb going off in my body. Never again! Since then I’ve been taking calcium and vitamin d and walking about 12 -14 miles a week. In 2008 my scores were hip -3.0 spine -3.8. Now I’ve had another scan and my scores are hips -3.1 spine -4.6. I have broken my wrists in the past 5 years.Received your book today and I’m really interested in the strontium . My questions are am I beyond help with these scores to keep the osteoporosis at bay or could I even dare hope I could improve them.I feel with the hip score not deteriorating as much the walking is helping but I am really worried about my spine.Would it be too dangerous to do supervised weight training exercises in a gym with these figures? Lara I have to say that the time you spend on answering all these comments is truly amazing.I hope you don’t mind doing one more.Thanking you in anticipation and best wishes from sunny Scotland. Believe me it does not happen very often! LINDA

Lara Pizzorno

Hello Linda,
The very kind people at Praktikos (the publisher of Your Bones) forwarded on your questions to me as well, and I have sent the following response back to them to send on to you. Since other people may be wondering about the questions you’ve asked, I’m posting my reply to you here as well.

First, of course I can find time to reply to you — YOU are the reason I wrote Your Bones!

In regards specifically to strontium — you should definitely consider adding strontium to your supplement regimen. This mineral has been proven to be very helpful in both lessening the rate of bone loss AND in promoting the rebuilding of new, healthy, fracture-resistant bone.
The three main issues in relation to strontium — (1) PLEASE do not take strontium ranelate, the patented drug form of strontium. It has been conclusively shown to cause a number of very nasty side effects; the two worst are VTE (venous thromboembolism–deep vein blood clots) and DRESS syndrome (symptoms initially are a rash, but this quickly progresses to fever, a very high white blood cell count (serious immune activation) and dangerous inflammation in various organs–liver, lungs, kidneys). DRESS requires immediate hospitalization and can be fatal. Obviously, VTE can also be fatal. Do not use strontium ranelate!
Natural forms of strontium — i.e., strontium citrate — do NOT cause either VTE or DRESS — or anything else harmful. The nasty side effects are only seen with strontium ranelate. I discuss strontium — the last 100 years of research — in detail in Your Bones. I tried to answer all the questions I could think of, but as you read through the book, you may still have some questions — do feel free to write me again.
(2) Be sure you are consuming at least twice as much calcium as strontium each day. 1,500 mg/day total from both food and supplements is the recommended amount of calcium for postmenopausal women (I am assuming you are postmenopausal and not on hormone replacement therapy (if you are considering hormone replacement it absolutely MUST be with bio-identical hormones — I discuss this in the book as well). The dosage of strontium shown effective in the research studies is 680 mg of elemental strontium — it’s written as “elemental” because strontium is a mineral salt (not salty, but a type of mineral that must combine with another compound to be stable — these are called “salts”), so you may see a much larger number on the label but this is referring to the total “salt” not the amount of strontium. Typically, the label will say how much “elemental strontium” is provided.
(3)Do not take your strontium when you are consuming supplements or foods rich in calcium. The two minerals compete for absorption, and calcium will always win this contest, so you will get little benefit from strontium if you take at the same time you ingest calcium. Take strontium at least 4 hours before or after you consume calcium. Many women have written me to say they have found it easiest to take their strontium at bedtime, which is 4 hours after they have eaten dinner. I find it easiest to take my calcium in the morning and evening when I brush my teeth, and to take strontium with lunch, but I do have to remember not to have calcium rich foods at my lunch meal. Whatever works best for you is the way to go.

Re exercise – walking is great, but do read the Bone Building Exercises chapter, pages 271-303. Given your DXA scores, I believe you would do best with Pilates initially — but be sure you are modifying the flexion exercises to strengthen your core muscles without risk of vertebral wedging. All this is explained in detail — along with photos — in the Bone Building Exercises chapter. With careful supervision at your gym, and using very light weights, you could try some of the exercises pictured in the chapter (e.g., squats). If you have access to a gym in which certified Pilates instructors are available, it would be great to work with someone who could first do a thorough postural analysis for you and then design a mat exercise workout that specifically meets YOUR needs. Once you have your workout organized, all you need is your body, a mat and a floor to put it on — then you can exercise at home and won’t have to spend $ on gym membership.

Two other very important suggestions:
Please have your vitamin D levels checked! You may not be taking enough. Optimal range is 60-80 ng/mL, not, as many doctors still are telling their patients, 30 ng/mL — anything below 30 ng/mL is considered frank deficiency now. Make sure you are taking vitamin D3 (not D2 — a less expensive and much less effective form) — all this is discussed at length in Your Bones.
Lastly, it is extremely important that you take vitamin K2, specifically the MK-7 form of K2. As I explain at length in Your Bones, vitamin D increases your body’s ability to absorb calcium; it does nothing to regulate where that calcium ends up. You want it to go into your bones. You do NOT want it to go into soft tissues, such as your heart, vasculature, kidneys, breast or brain! Putting calcium into bones and keeping it OUT of soft tissues is the job of vitamin K dependent enzymes – in other words, enzymes that will not work without vitamin K.
The latest research, a 3 year study using K2 (MK-7) at a dose of 180 mcg/day in postmenopausal women to prevent bone loss indicates that these amounts cause no side effects and are highly likely to be sufficient for apparently healthy individuals. You should be taking at least 180 mcg per day. (here’s the reference for this paper in case you want to share it with your doctor: Knapen MH, Drummen NE, Smit E, Vermeer C, Theuwissen E. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporos Int. 2013 Mar 23. [Epub ahead of print] PMID: 23525894)

Are you now in the US or are you still in Scotland? I am hoping to be in Scotland for a few days this coming September; my husband, Dr. Joe Pizzorno and I are speaking at a conference in London the end of the month, and we are doing our best to free up a few days beforehand to come see a bit of your beautiful land. I have some Scottish roots — my great-great grandparents on my father’s side lived near Dumfries, and I have only managed to visit Scotland once, very briefly when I was 21. As I will turn 65 in October, another visit is way past due! I am a STOTT Pilates instructor myself. Should you still be in Scotland and should we be fortunate enough to be able to come visit, I would be happy to meet with you, check your alignment and give you some mat work suggestions. If you are still in Scotland, and it looks like we will be coming, I’ll let you know.

Be well,


Thank you so much for this information. I was a bit nervous about taking the strontium after reading certain websites, so the research has put my mind at ease.

I noticed that there is 800 IU of Vitamin D in the AlgaeCal. When my vitamin D levels were tested last year, I was told that I was really low and should be taking 2000 units. Is it ok to add an additional vitamin D supplement, like 1,000 IU? I just want to make sure I’m not creating an imbalance in how the supplements are formulated and intended to be taken.
Thank you!

Lara Pizzorno

Hello Joy,

The full dosage of AlgaeCal Plus is 2 capsules twice daily, so if you are taking the full amount recommended, you will be getting 1,600 mg of Vitamin D3.
If your levels of 25(OH)D are quite low, however, this will not be sufficient for YOU. It your blood levels are of 25(OH)D — this is the form in which vitamin D circulates in the bloodstream and is used as the marker of your vitamin D levels in the body — are less than 30 ng/mL, you are vitamin D deficient. Optimal levels are 60-80 ng/mL.

You should discuss with your doctor taking additional vitamin D3 for 3 months and then retesting your blood levels of 25(OH)D. The Vitamin D Council recommends taking 5,000 IU per day for 3 months and then retesting. Vitamin D3 can be purchased in capsules containing 1,000IU and 2,000IU. I would suggest taking at least an additional 3,000 IU of Vitamin D3 along with your AlgaeCal Plus for 3 months and then retesting your 25(OH)D levels. This will not create an imbalance among the other nutrients included in AlgaeCal Plus.

If after taking around 5,000 IU for 3 months your blood levels of 25(OH)D are still too low, you may find you require as much as 10,000 IU of vitamin D3 daily to get your 25(OH)D into optimal range. If this is the case for you, you will need to also take additional K2 (MK-7) — an additional 100-200 mcg per day would be advisable.

Hope this helps,

linda munnoch

Hi Lara, Thanks so much for your fantastic reply. Just finished your book-absolutely brilliant. I learned so much! So I’ve got my algae cal my strontium, I’m having my vitamin d levels checked and my doctor was very sympathetic to the regime I wanted to try.I took my 3 strontium tablets (strontium boost) last night and, trying to phrase this delicately, three hours later I was trotting to the loo. Needless to say I’m feeling a bit exhausted this morning. Should I introduce the strontium gradually, building up from one pill to two to three over a period of time or should I take one pill three times a day? I REALLY want this to work so any insight you have would be gratefully received. All my love Linda

Lara Pizzorno

Hi Linda,
You are so welcome! Delighted you are working with a receptive physician! You are most likely an ambassador of new information for your doctor, and hopefully, what will be learned will get passed on to help other patients as well.
Re strontium — I have not heard of its causing diarrhea (sorry, less delicately phrased), but the first rule, ALWAYS, is to trust YOUR own body and its reactions to anything recommended. Absolutely, cut back to 1 capsule of strontium and see how that works for you. It’s possible you reacted to something else you ate or were exposed to (environmental chemicals, bacteria, etc.) and not the strontium citrate. Just go very slowly and see what happens. If you tolerate 1 capsule, after several days of taking just 1, take 2, and see how you do. Taking 1 capsule several times a day will be a bit of a hassle as you must take strontium several hours before or after consuming calcium, so it would be easier to take 2-3 at once. But remember, YOUR body may prefer a lesser dose, period. Even 1 capsule per day is going to be doing some good for your bones.
Let me know how your personal clinical trial turns out, and Be well!

PS–if you are eating gluten-containing grains, I urge you to consider eliminating them (wheat, barley, rye). The latest research, which I am just now writing up for medical journal articles for docs after hearing about all this at the Institute for Functional Medicine’s 2013 symposium, clearly shows that humans are unable to fully digest gluten; we can only break it down into indigestible peptide fragments, one of which, called gliaden, will cause not just diarrhea, but is now being shown to promote all kinds of autoimmune diseases — not just celiac disease, but Hashimoto’s thyroiditis, multiple sclerosis, rheumatoid arthritis, even cancer. Modern wheat has been greatly hybridized over the last 50 years and contains WAY more gluten (gliaden) than wheat used to, and the food industry now also “deanimates” wheat to make it water-soluble, and thus easier to use in producing products. The end result of all this is that wheat has become much more harmful for us. It will definitely be causing inflammation for you, and as you know after reading Your Bones, chronic low grade inflammation actives osteoclasts and causes excessive bone loss. If you want to read more about all this, the head of the research team primarily involved (now at Harvard) is Alessio Fassano, MD. You can look him up on Google — much is now being written about this, and not just in the medical journals, but also for the public at large.

linda munnoch

Hi Lara, Thanks for your reply. You were correct. It must have been something else that upset my stomach and I am now taking all the pills with no side effects. Interesting what you are saying about gluten. I’ve been attending a homeopathic doctor for 25 years now and she always advises her patients to adopt a wheat free diet. Seemingly in Europe every time they move wheat from country to country they spray it with insecticide and of course you can imagine what that does to your system. I’ve noticed in your previous posts that you take your strontium with lunch. May I ask what sort of foods you eat so that they don’t compete with the strontium? Thanks again Linda

Lara Pizzorno

Hi Linda,
Great! As I mentioned, there have been no reports of stomach upset caused by the natural form of strontium, strontium citrate, in any of the studies conducted over the last 100+ years.
Re what I eat for lunch — typically, I have lots of vegetables (raw salads –e.g.,greens, cole slaw, cucumber salad, lightly steamed vegetables like broccoli, carrots, cauliflower and/or roasted vegetables like beets, squash, potatoes, yams, etc.). For protein, I add in a hard boiled omega-3-rich egg or 1/2 cup of beans (black beans, garbanzos, lentils, pinto beans, etc), or a couple of ounces of omega-3 rich fish (canned sardines, salmon, mackerel — all are extremely low in mercury, quick and easy to fix). When available–as now in our garden–I top my raw greens salad with some fresh blueberries. I also often add a handful of organic nuts (walnuts, pumpkin seeds, pine nuts, almonds, cashews, pecans–etc.) I use organic extra virgin olive oil and balsamic vinegar for salad dressing. I eat the calcium-dense foods (e.g., yogurt, goat cheese, cottage cheese, soymilk enriched with calcium, tofu, spinach) at breakfast and dinner. We do not eat meat, but if you do, be sure you choose meat from pasture-fed animals, not feedlot beef or cows that are given corn (which is typically GMO as well!) Meat from free range, pastured animals should be good for you — when consumed in small amounts along with plenty of vegetables.
Re wheat — I have just wrapped up my review of Alessio Fassano’s lecture on wheat/gluten-containing grains at the Institute for Functional Medicine’s 2013 symposium. In doing so, I read through much of his published research and that of a number of others regarding gluten. I will no longer eat it! Human beings cannot properly fully digest gluten — even if no apparent digestive upset occurs, it still is provoking at least 5 different and very nasty immune system reactions, plus causing a leaky gut. Gluten is a MAJOR contributing factor to all forms of auto-immune disease and its preferential target in the body is the brain and nervous system. NO THANK YOU! There are quite a few other delicious grains we can have — including quinoa, millet, brown rice — if we want the extra carbs. I find my body has more energy, sleeps better and just feels better when I minimize my grain intake. I do much better with starchy whole vegetables like potatoes, yams, corn, beets, winter squash. These are very filling and delicious and suit my physiology better than grains. You simply must experiment and see what works best for you. Regardless,, however, I urge you to NOT EAT GLUTEN-CONTAINING GRAINS! Modern wheat has been hybridized greatly over the last 50 years and is also deanimated (a process used to make the flour water soluble, so easier to use for food products) — the end result of all this is that modern wheat is MUCH more destructive to us than wheat used to be. It will definitely cause inflammation in your body — and as you know if you have read Your Bones — anything that provokes chronic inflammation activates osteoclasts excessively and causes bone loss.
Stay well, Lara


Great article, it clears up my concern for safety and Strontium! I was wondering what your thoughts are regarding taking strontium citrate along with Boron to help build stronger bones? And is Boron safe in your opinion?

Lara Pizzorno

Hello Joe,

Thanks for the compliment, very glad my article set your mind at ease regarding the use of strontium citrate to safely help you rebuild healthy bones.

Regarding boron, this trace mineral is also definitely needed. It is required for a reaction that occurs in the kidneys in which vitamin D is converted into its most active form (the form in which it is going to enable your body to effectively absorb calcium) and for the conversion of estrogen into the form in which it increases the bones’ absorption of magnesium, a key component of the crystal latticework that gives structure to our bones, (and yes, men produce — and need — a wee bit of estrogen; this tiny amount is critical for men’s bone health). I explain all this in detail in Your Bones, 2nd edition, pp. 223-224.

Although you only need 3 milligrams of boron daily, this is a trace mineral that is difficult to get even in that small amount from the diet. So it is best to take a supplement. You can, of course, purchase boron separately (and have to open yet another bottle and take yet another pill every day), but I, personally, just rely on AlgaeCal Plus, which contains not only the calcium our bones require, but also the 3 milligrams of boron, plus magnesium and vitamin D3.

Hope this helps, Lara


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Thank you so much for this information. I was a bit nervous about taking the strontium after reading certain websites, so the research has put my mind at ease.


Hi Lara, I stumbled upon this website. At age 65, I just had a dexa scan with score of -2.8. My Dr. prescribed fosomax 70 mg. weekly dose, and mybloodwork showed very low Vitamin D. Dr put me on high dose Vitamin D for 8 weeks. I am not fond of the results I read about Fosomax and don’t take any other prescriptions. I want to stay away from fosomax and I am looking into taking a different calcium ( have been taking new chapter bone strength at 1/2 the recommended dose ) The Vitamin Code Grow Bone looks good. Lara, what do you think of Vitamin Code Grow Bone. It is 2 different things, with taking strontium at bedtime and Vitamin Code Raw Calcium 4 tabs between breakfast and dinner. Thanks!

Lara Pizzorno

Hello Ann,

I urge you to read Your Bones, 2nd edition, to become fully informed re Fosamax and the other bisphosphonates, and the other drugs prescribed for osteoporosis, Prolia (denosumab) and Forteo (teriparatide). There are MANY causes of bone loss, none of which are treated by these drugs, and all have numerous adverse effects. I agree with you that determining why YOU are losing bone, correcting the causes of YOUR bone loss, and providing your bones with all the nutrients they must have to rebuild healthfully is your best option. In fact, it is your only true option for reclaiming healthy bones. In Your Bones, I discuss the many causes of bone loss and all the nutrients our bones require to help you devise a plan that will work for YOU. Simply knowing your age and DXA score does not even come close to providing me with the information necessary to advise you fully. You must become well informed, think about what might be contributing to your bone loss, and then if you write me with specific questions, I will do my best to help you.

Re calcium supplements — just calcium, even if accompanied by a few other nutrients, e.g., vitamin D, is not going to do the job. I use AlgaeCal Plus because it provides not just calcium (although it naturally contains 4 different types of calcium), but the entire diversity of trace minerals utilized by the marine algae to build its bony structure, plus vitamin D3, plus vitamin K2, plus extra magnesium, vitamin C and boron. Because it is derived from the marine algae, Algas calcarius, it also naturally contains the full spectrum of trace minerals. Our modern diets are sorely lacking in these minerals, and our bones require virtually all of them for optimal health. No other calcium supplement I know of provides this.

One further comment re vitamin D — if you are taking vitamin D and calcium, especially if you are taking high dose vitamin D, you absolutely MUST be taking vitamin K2 (the MK-7 form of K2). Vitamin D greatly increases our absorption of calcium from the intestines into the bloodstream. It does NOTHING to determine where that calcium ends up in our bodies. That is the job of the enzymes that require K2 as their co-factor. These include osteocalcin, which puts calcium into bone, and matrix Gla protein, which keeps it out of our arteries, heart, kidneys, breasts and brain. It is imperative that you start taking K2 right away! K2 and vitamin D (I hope you are taking the D3 form as it is much more effective than D2) work together and must be in balance — in fact, vitamin D causes an increase in the production of the vitamin K-dependent proteins (e.g., osteocalcin, matrix Gla protein), so taking vitamin D without adequate vitamin K2 will cause a functional deficiency in K2. I don’t know how much vitamin D you are taking or what your blood levels are of 25(OH)D [optimal range is 60-80 ng/mL], but I suggest you take at least 120 mcg/day of MK-7. I have written about all this in detail in Your Bones, 2nd edition. I believe the book is available in public libraries in the U.S. if you don’t want to purchase a copy — as it is published by a non-profit, cost is very low, around $10.00. Please read it and write me with your questions when you have a better idea of what might be the reasons for YOUR bone loss.



Dear Lara,
Thanks for writing back. I got your book from our library here and is enlightening that all that information is in there.I am slowly getting informed and changing the way I eat to see if I can feel better, because I am not going to take drugs for the osteoporosis. I know in 2014 that I felt worse than in 2013. One thing different is I layed out in the sun and got a good tan, not this year. Will go and lay out this coming summer
So Vitamin D was low, me not drinking any milk but eating 1/2 cup cottage cheese daily. I have not had milk to drink for a long time, so now drink 3 cups milk daily and eat 1 cup of yogurt daily. I will be looking into calcium fortified orange juice also Before now, I took a multivitamin and half the full dose of Bone Strength Take Care. Now take 4 capsules Bone Grow Raw Calcium between breakfast and dinner and a multivitamin. Also taking Vitamin B and Vitamin C. Next, my diet needs to get overhalled as well getiting the foods out that cause calcium to go out of bones faster. I have given up coffee, and need to watch the sugar. Its a start there is so much to learn!


Hello Lara,
Bless you for all you do for people concerning our bone health, etc.
You are truly brilliant.
I am 70 and take real good care of myself. However, with my Osteoporosis DXA results I now have a lower score -3.5 on my femoral neck part of my hip bone, and other parts the low score has progressed.
The dr. recommends Prolia and absolutely am against that poison!
I want to get on the AlgaeCal and Strontium Boost ASAP but I have Thrombocytopenia ( low blood platelets 60k and need to be over150k).
I need to know ASAP if the Strontium.Citrate is safe to take with my blood platelet problem. My thinking is that the platelets are made in the bone marrow and if the Osteoblasts and Osteoclasts start to function correctly through the AlgaeCal and StrontiumCitrate and all the other factors involved in the healthful regimen, then, perhaps, my platelet count would
actually improve!
Please respond as soon as possible as have searched for 2 days on the Internet and could not find the answer to the StrontiumCitrate/ Thrombocytopenia safety issue.
I highly respect all that you do. Thank you sincerely!

Lara Pizzorno

Hi Lynn,

You can safely take strontium citrate. Strontium citrate, a natural form of strontium, is not associated with any type of blood disorder, including thrombocytopenia (low platelet count). In fact, strontium citrate is associated with no adverse reactions at all. I just checked PubMed for the latest to be absolutely certain nothing new had been published in the last few months — and no ADRs of any kind are associated with strontium citrate.

This is not the case for the drug form of strontium, strontium ranelate, which increases risk significantly for a number of ADRs, including VTE (formation of a blood clot in the deep veins in the leg). However, even strontium ranleate, which I certainly do not recommend, is not associated with lowered platelet count.

I suggest you start out taking half the recommended amount of Strontium Boost (so 1 capsule daily) for a week or two, then increase to the full dosage of two capsules per day.

And now to a possibly more important question for you — what is causing your low platelet count? A common cause of thrombocytopenia in us older folks (I am now 67) is vitamin B12 deficiency. Are you secreting sufficient hydrochloric acid (stomach acid) to enable you to absorb vitamin B12? The absorption of B12 is a bit complicated.

B12 is bound to proteins in animal-derived foods (e.g., meat, eggs, dairy products) and must first be separated from them with the help of stomach acid and pepsin. It then immediately combines with a carrier called transcobalamin and enters the small intestine where pancreatic enzymes release it, so it can join with another carrier called intrinsic factor. Intrinsic factor, like stomach acid is secreted by cells in the lining of the stomach (called parietal cells). “B12 + intrinsic factor” then travels almost the entire length of the small intestine (to the terminal ileum) where it binds to specific receptors and FINALLY is absorbed into the bloodstream. IF your stomach acid secretion is low OR you are not secreting sufficient pancreatic enzymes or intrinsic factor, your ability to absorb B12 will be wiped out. Obvioiusly, if you frequently take acid blocking drugs, your ability to absorb B12 will be impaired.

Even if you are taking good care of yourself and eating well, aging is associated with gradual decline in the lining of the stomach (called gastric atrophy) and thus lessened secretion of digestive juices. Older adults (anyone over age 60) are at higher risk of gastric mucosa atrophy, lowered stomach acid secretion and altered production of intrinsic factor.
Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract. 2006 Apr;12(2):110-8. PMID: 16529597
Brito A, Hertrampf E, Olivares M, et al. [Folate, vitamin B12 and human health]. [Article in Spanish] Rev Med Chil. 2012 Nov;140(11):1464-75. doi: 10.4067/S0034-98872012001100014. PMID: 23677195

In large surveys in the United States and the United Kingdom, approximately 6% of those aged 60 or older are vitamin B-12 deficient (plasma vitamin B-12 less than 148 pmol/L), and the prevalence of deficiency increases with age. Closer to 20% have marginal (not deficient but not good either) B12 status (plasma vitamin B-12: 148-221 pmol/L) in later life.
Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009 Feb;89(2):693S-6S. doi: 10.3945/ajcn.2008.26947A. Epub 2008 Dec 30. PMID: 19116323

And these surveys were done using only plasma (blood) B12 as the marker of sufficiency. Plasma B12 alone is not an adequate marker because it does not indicate if B12 is active inside cells, just the amount of B12 floating around in the bloodstream. The plasma (serum) B12 test should be combined with labs for methylmalonic acid and homocysteine levels, both of which rise when B12 is insufficient and are thus suggestive of B12 insufficiency. Estimates of the incidence of B12 insufficiency rise from 20% to 24% and 46% among free-living and institutionalised elderly, respectively, when methylmalonic acid is used as a marker of vitamin B12 status. Cuskelly GJ, Mooney KM, Young IS. Folate and vitamin B12: friendly or enemy nutrients for the elderly. Proc Nutr Soc. 2007 Nov;66(4):548-58. PMID: 17961276

If you are not certain your B12 status is excellent, please check! Low B12 impacts bone health by causing levels of homocysteine to rise – and homocysteine is highly inflammatory, a real terrorist igniting inflammation everywhere throughout your body. Inflammation activates osteoclasts, the cells that break down bone. When activated too frequently, the result is osteoporosis. Low B12 is an easy fix. You can ask your doctor about using B12 injections for a while to boost your levels quickly and also take B12 in the form of an intranasal spray, which allows B12 to be absorbed directly into the bloodstream.

Here’s a link the homocysteine and MMA tests offered by one of several on-line labs that offers these, but your doctor may be willing to prescribe them for you, and they should be covered by your health insurance.:

Be well,


Hello Laura!
I am looking into incorporating strontium citrate along with Algae Cal (which I am already taking) into my daily regime. I have not come across any contraindications for the immune suppressed lifestyle, other than the possibility of DRESS which is not very applicable anyway. Do you know of any? I am 27 months out from a heart and double lung transplant and my last bone density results scared me. I can only imagine what it would of been without taking Algae Cal this past year. My bones were great prior to transplant surgery, a bit of osteopenia but nothing dramatic especially considering the years of cortico & oral steroid use. Now the culprits are Prograf, Imuran and Prednisone (maintenance levels) not to mention all the drugs in between which kept me alive until I got to this point. And maybe the beginning of menopause is also adding to the bone loss. Any thoughts on the matter greatly appreciated as well,
thank you!


Hi Laura,
I was diagnosed with osteoporosis (-2.5 in the lower spine) only 6 weeks ago after a DEXA scan and have since been doing a lot of research since. My only risk factors are hereditary (my mother has osteoporosis) and being of slight build. I am otherwise fit, healthy and consume a vegetarian mostly alkaline diet. Since the diagnosis I have started osteo/pilates classes twice a week and doing 15 minutes of weight-bearing exercises 2-3 times a week. I have also started taking supplements as recommended by my naturopath: Vitamins D3 &, K, magnesium, Omega 3 fish oil, Met calcitite osteo and Met fibrolex.
After reading your website I am considering taking Algaecal but wonder whether I should wait a period of time, eg 6 months, to see if the current regime is working. My question is if I start taking Algaecal and find my DEXA scan shows my bone density improves then I won’t know what has attributed to the improvement.
Also can you advise how long I would need to take Algaecal for. I live in Australia so the cost of it is very high.
I look forward to your reply.

Lara Pizzorno

Hi Val,

Sure, you can wait 6 months and then see if what you are doing is helping.

To give you more feedback — besides the fact that what you are currently doing is definitely not equivalent to what you would be doing if you were taking AlgaeCal (in contrast to what you are currently taking, AlgaeCal Plus provides 4 different types of plant-derived calcium, 70+ trace minerals, many of which are required for healthy bone remodeling, and 3 mg of boron, which we now know is extremely important for bone, particularly after menopause) – I would need to know a few specifics about you and your current program:

What is your blood level of vitamin D (25(OH)D)? Where you are determines how much D3 you should be taking daily, and this determines how much K2 you need as these nutrients need to be in balance. Your 25(OH)D level should be between 50-80 ng/mL.

What is your omega-6: omega-3 ratio? This impacts how much supplemental EPA/DHA you need. You want to have an omega-6:omega-3 ratio of no more than 4:1.

How much magnesium are you taking? Your magnesium intake (from diet & supplements) should be at least half as much as the amount of calcium you are consuming (from both diet & supplements). You need 1,200 mg of calcium daily and at least 600 mg of magnesium daily.

AlgaeCal supplies properly balanced amounts of calcium, magnesium citrate, D3 and K2 (MK-7).

I am not familiar with the “Met” line of supplements so don’t know how much or what forms of the nutrients provided you are getting. Let me know, and I will send you a more detailed, specific response.

Re AlgaeCal — you should expect to see an improvement within 6 months. To continue to improve (or to maintain) the health of your bones, you will need to continue to take it. Think about this — AlgaeCal provides optimal nutrition for your bones, whose need for a steady supply of these nutrients does not stop because our bones keep remodeling throughout life. Every 10 years, every cell in your body (including those that make up your bones) will have been replaced with new cells. The quality of what gets built will depend upon what building supplies were available.

I understand that the cost of AlgaeCal is higher in Australia. I wish this were not the case! However, the health of your bones is extremely important for your overall health and life expectancy. In sum, your bones are well worth the expense. If you can order at least a 6 months’ supply, this should help lower the cost.

Hope this helps,


Hello Lara, I have learned a great deal about strontium citrate and the other bone supplements reading the answers to the questions posted. Thank you! One thing I learned was not to eat any calcium rich foods within a couple of hours of taking the strontium citrate. I did not know that; I did take the strontium citrate shortly after eating my breakfast cereal with almond milk, which was fortified with calcium. I now know that the strontium citrate was not likely too well absorbed, but are there any negative side effects of taking strontium citrate and eating a calcium rich meal? I have been breaking out in several small red itchy bumps all over my body and my skin feels “chapped”, including my eye lids. I only took the strontium for a few weeks, but could my skin issues be an side effect of the way I took the strontium citrate? I did take my actual calcium, Vit D, Magnesium, B vitamins, etc…later in the day as well. Your thoughts on this would be most appreciated. Thank you!

Lara Pizzorno

Hi Jannine,

The only negative effect of taking strontium citrate along with a calcium-rich meal is that you will get little, if any, benefit from the strontium. As I explained, calcium and strontium compete for absorption, and calcium will always be preferentially absorbed.

Regarding your skin — it is extremely unlikely that strontium is the cause of your itchy bumps or chapped-feeling skin. Strontium ranelate — the prescription drug form of strontium — is associated with a very serious rash-like syndrome called DRESS syndrome, so if you were taking that, I would be telling you to head to the emergency room right away!. Strontium citrate, however, has never been found to cause this — or any of the other ADRs produced by strontium ranelate.

You are most likely to be having a reaction to something in your environment — a housecleaning, hair or body care product you are using. Or you could have become sensitive to some component in your food. A number of the plethora of supposedly safe food additives in processed foods–preservatives, food colorings, “fake” flavorings, etc.–may be problematic in some individuals.
Also, if your digestion is impaired or you are taking an acid-lowering drug, you will not be properly breaking down the proteins in your food, and undigested protein fragments that gain entry into your bloodstream can provoke many kinds of adverse reactions, including the skin symptoms you are experiencing.

I suggest you take a careful look at the labels on the housecleaning and body care products you are using and eliminate any that may be suspect for 4-5 days. Also read the labels on the processed foods you eat — anything that comes in a can, box or plastic package and has a bunch of chemicals added. If something has lots of additives, eliminate it. It would also be a very good idea to increase your intake of probiotics (beneficial digestive tract bacteria). Yogurt is a great option here — if dairy products agree with you, look for whole milk, organic yogurt from pastured cows, which will also provide vitamin K2 as well as calcium for you. It’s important that the yogurt be full-fat, not reduced fat. Vitamin K2 is fat-soluble — it’s in the fat, so when the fat is removed, so is the K2. My favorite is plain, organic, whole milk Greek yogurt — we have a dish full every night along with some berries or other fruit and a handful of nuts or gluten-free granola for dessert. Try this and your taste buds as well as your digestive tract and bones will be delighted with you. If you cannot tolerate dairy, then look for yogurt made from organic soybeans or coconut. Kombucha is another excellent dairy-free source of pro-biotics. And so are my gluten-free sourdough breads — you can find the recipes here (add link)

Please just try these suggestions for 1 week — you are very likely to not only see your skin issues resolve but to feel more vital overall. Let me know how you do.

Be well,


Hello Lara, thank you for the information you have provided on this site. I have learned quite a bit about strontium citrate, including how/when to take it. I took the strontium citrate via a supplement through Orth Molecular called “0ro Bono”. That supplement is broken up into “AM” and “PM” formulations. The “AM” packet contains 1g of strontium citrate. I took it for a few weeks, but didn’t realize that I should also have avoided calcium in food when taking the “AM” packet that contained the Strontium Citrate, so I now realize that I should have avoided eating my cereal and almond milk for breakfast, as it contained calcium. My question is, are there any negative side effects of taking the strontium citrate and calcium around the same time? I am asking because I am getting small, itchy red bumps on my skin as well as my ski feeling kind of sun burned and wondering if it could be related to the strontium citrate. Your thoughts would be much appreciated.

Lara Pizzorno

Hi Jannine,

I have replied to your similar comment above.

– Lara


Thank you so much for responding, Lara and for responding so quickly. I apologize for posting my message twice. Initially, it did not appear that my first message went through.

I have tried to identify any new substances in my environment and haven’t been able to identify a single one. I am very conscientious of my diet and eat very, very few processed foods. That said, your suggestion is a good one and I will keep a diary for a couple of weeks and see if something turns up.

Thank you again for your response. It really helped put my mind at ease.

Anne Walch

Hello Lara,

I was wondering if you had seen this article from Univ of Toronto, re lyme (borrelia burgdorferi) causing bone loss?

“The bacteria were not only detectable in the bones of mice, they were seen to cause significant bone loss in the longer bones, mere weeks after infection.

In fact, the bone loss developed at a rapid rate, taking just four weeks to advance to osteopenia, a forerunner to the more severe form of bone loss disease, osteoporosis. The study found that the amount of bone loss directly correlated to the bacterial load found in the bones. The more bacteria present, the greater the rate of bone loss.”

This is relevant to me (lyme and severe osteoporosis) and with a pa