Absorption of strontium from the gastrointestinal tract into plasma in healthy human adults

Strontium Ranelate and Strontium Chloride Supplementation Influence on Bone Microarchitecture and Bone Turnover Markers-A Preliminary Study

Despite strontium ranelate use in osteoporosis management being one of the promising concepts in disease treatment, there is no clear evidence that strontium organic compounds are more effective than inorganic ones. The aim of this study was to compare strontium chlorate and strontium ranelate influence on the mice bone microarchitecture. We investigated whether strontium chlorate (7.532 mmol/L) and strontium ranelate (7.78 mmol/L) solutions fed to healthy SWISS growing mice (n = 42) had an influence on the percent of bone volume (BV/TV), trabecular thickness (Tb.Th), number of trabeculae (Tb.N), and separation between each trabecula (Tb.Sp) in the chosen ROI (region of interest) in the distal metaphysis of the left femurs. The cortical bone surface was examined close to the ROI proximal scan. There was an increase in each examined parameter compared with the control group. There were no statistical differences between strontium ranelate and strontium chlorate parameters. Our study indicates that organic and inorganic strontium compounds similarly affect the bone microarchitecture and strength.

La Sassa cave: Isotopic evidence for Copper Age and Bronze Age population dynamics in Central Italy

This study focuses on the changes in diet and mobility of people buried in the La Sassa cave (Latium, Central Italy) during the Copper and Bronze Ages to contribute to the understanding of the complex contemporary population dynamics in Central Italy. To that purpose, carbon and nitrogen stable isotope analyses, strontium isotope analyses, and FT-IR evaluations were performed on human and faunal remains from this cave. The stable isotope analyses evidence a slight shift in diet between Copper and Bronze Age individuals, which becomes prominent in an individual, dating from a late phase, when the cave was mainly used as a cultic shelter. This diachronic study documents an increased dietary variability due to the introduction of novel resources in these protohistoric societies, possibly related to the southward spread of northern human groups into Central Italy. This contact between different cultures is also testified by the pottery typology found in the cave. The latter shows an increase in cultural intermingling starting during the beginning of the middle Bronze Age. The local mobility during this phase likely involved multiple communities scattered throughout an area of a few kilometers around the cave, which used the latter as a burial site both in the Copper and Bronze ages.

On the premises of mixing models to define local bioavailable 87Sr/86Sr ranges in archaeological contexts

In archaeological mobility studies, non-local humans and animals can be identified by means of stable strontium isotope analysis. However, defining the range of local ⁸⁷Sr/⁸⁶Sr ratios is prerequisite. To achieve this goal, proxy-based mixing models have recently been proposed using ⁸⁷Sr/⁸⁶Sr ratios measured in modern local vegetation, water and soil samples. Our study complements earlier efforts by introducing archaeological animal bones as an additional proxy. We then evaluate the different modelling approaches by contrasting proxy-results generated for the county of Erding (Upper Bavaria, Germany) with a comprehensive set of strontium measurements obtained from tooth enamel of late antique and early medieval human individuals (n = 49) from the same micro-region. We conclude that current mixing models based on environmental proxies clearly underestimate the locally bioavailable ⁸⁷Sr/⁸⁶Sr ratios due to the limited sample size of modern environmental specimens and a suit of imponderables inherent to efforts modelling complex geobiological processes. In sum, currently available mixing models are deemed inadequate and can therefore not be recommended.

Modeling elemental strontium in human bone based on in vivo x-ray fluorescence measurements in osteoporotic females self-supplementing with strontium citrate

An in-house custom I-125 excited in vivo x-ray fluorescence (IVXRF) system was used to perform bone strontium (Sr) measurements in individuals suffering from osteoporosis and/or osteopenia. These individuals, who were self-administering with Sr supplements of their choice, were measured frequently, ranging from weekly to biweekly to monthly, over four years, as part of the Ryerson and McMaster Sr in Bone Research Study. Based on these data collected, data from eight subjects were used to perform kinetic modeling of Sr in human bone. Power and exponential models were used to model the data based on one and two compartmental systems. Model parameters included: mean normalized baseline bone Sr signal, half-life and bone Sr uptake. A one compartmental exponential model applied to finger and ankle bone measurements gave half-lives of (508  ±  331) d and (232  ±  183) d, respectively, but did not show statistically significant differences (p  =  0.087 96). However, the values fall within literature estimates. When a two compartmental model was applied to finger bone measurements, half-lives of (300  ±  163) d and (2201  ±  1662) d were observed. Ankle bone data gave half-lives of (156  ±  117) d and (1681  ±  744) d. A two sample t-test, assuming unequal variances, showed these half-lives to be statistically different in both the finger and ankle bone measurements (p  =  0.0147 and p  =  0.00711, respectively). Common kinetic parameters amongst the different subjects could not be unambiguously identified due to the wide scatter of data, leading to an inconclusive kinetic model. The wide distribution of data is suggested to be physiological since technical and positioning factors were eliminated as possible causes. This outcome indicates the need for a more controlled study and further understanding of the physiological mechanism of Sr absorption.

Strontium biokinetic model for the lactating woman and transfer to breast milk: application to Techa River studies

This paper presents a biokinetic model for strontium metabolism in the lactating woman and transfer to breast milk for members of Techa River communities exposed as a result of discharges of liquid radioactive wastes from the Mayak plutonium production facility (Russia) in the early 1950s. This model was based on that developed for the International Commission for Radiological Protection with modifications to account for population specific features of breastfeeding and maternal bone mineral metabolism. The model is based on a biokinetic model for the adult female with allowances made for changes in mineral metabolism during periods of exclusive and partial breast-feeding. The model for females of all ages was developed earlier from extensive data on (90)Sr-body measurements for Techa Riverside residents. Measurements of (90)Sr concentrations in the maternal skeleton and breast milk obtained in the1960s during monitoring of global fallout in the Southern Urals region were used for evaluation of strontium transfer to breast and breast milk. The model was validated with independent data from studies of global fallout in Canada and measurements of (90)Sr body-burden in women living in the Techa River villages who were breastfeeding during maximum (90)Sr-dietary intakes. The model will be used in evaluations of the intake of strontium radioisotopes in breast milk by children born in Techa River villages during the radioactive releases and quantification of (90)Sr retention in the maternal skeleton.

Strontium biokinetic model for the pregnant woman and fetus: application to Techa River studies

A biokinetic model for strontium (Sr) for the pregnant woman and fetus (Sr-PWF model) has been developed for use in the quantification of doses from internal radiation exposures following maternal ingestion of Sr radioisotopes before or during pregnancy. The model relates in particular to the population of the Techa River villages exposed to significant amounts of ingested Sr radioisotopes as a result of releases of liquid radioactive wastes from the Mayak plutonium production facility (Russia) in the early 1950s. The biokinetic model for Sr metabolism in the pregnant woman was based on a biokinetic model for the adult female modified to account for changes in mineral metabolism during pregnancy. The model for non-pregnant females of all ages was developed earlier with the use of extensive data on (90)Sr-body measurements in the Techa Riverside residents. To determine changes in model parameter values to take account of changing mineral metabolism during pregnancy, data from longitudinal studies of calcium homeostasis during human pregnancy were analysed and applied. Exchanges between maternal and fetal circulations and retention in fetal skeleton and soft tissues were modelled as adaptations of previously published models, taking account of data on Sr and calcium (Ca) metabolism obtained in Russia (Southern Urals and Moscow) relating to dietary calcium intakes, calcium contents in maternal and fetal skeletons and strontium transfer to the fetus. The model was validated using independent data on (90)Sr in the fetal skeleton from global fallout as well as unique data on (90)Sr-body burden in mothers and their still-born children for Techa River residents. While the Sr-PWF model has been developed specifically for ingestion of Sr isotopes by Techa River residents, it is also more widely applicable to maternal ingestion of Sr radioisotopes at different times before and during pregnancy and different ages of pregnant women in a general population.

Age and gender specific biokinetic model for strontium in humans

A biokinetic model for strontium in humans is necessary for quantification of internal doses due to strontium radioisotopes. The ICRP-recommended biokinetic model for strontium has limitations for use in a population study, because it is not gender specific and does not cover all age ranges. The extensive Techa River data set on (90)Sr in humans (tens of thousands of measurements) is a unique source of data on long-term strontium retention for men and women of all ages at intake. These, as well as published data, were used for evaluation of age- and gender-specific parameters for a new compartment biokinetic model for strontium (Sr-AGe model). The Sr-AGe model has a similar structure to the ICRP model for the alkaline earth elements. The following parameters were mainly re-evaluated: gastrointestinal absorption and parameters related to the processes of bone formation and resorption defining calcium and strontium transfers in skeletal compartments. The Sr-AGe model satisfactorily describes available data sets on strontium retention for different kinds of intake (dietary and intravenous) at different ages (0-80 years old) and demonstrates good agreement with data sets for different ethnic groups. The Sr-AGe model can be used for dose assessment in epidemiological studies of general populations exposed to ingested strontium radioisotopes.

Assessing the reliability of dose coefficients for ingestion and inhalation of 226Ra and 90Sr by members of the public

Assessments of risk to a population group resulting from internal exposure to a particular radionuclide can be used to assess the reliability of the appropriate International Commission on Radiological Protection (ICRP) dose coefficient, E(50), used as a radiation protection device for the specified exposure pathway. An estimate of the uncertainty on the risk is important for informing judgements on reliability. This paper describes the application of parameter uncertainty analysis to quantify uncertainties resulting from internal exposures to radioisotopes of the alkaline earth metals, (90)Sr and (226)Ra, by members of the UK public. The study derives uncertainties in biokinetic model parameter values to calculate the distributions of the effective dose per unit intake using the ICRP Publication 60 formalism. The distributions are used to infer the uncertainty on the mean effective dose per unit intake to inform the derivation of uncertainty factors (UF) for the appropriate ICRP Publication 72 dose coefficients. Here, a UF indicates a 95 % probability that the best estimate of risk per unit intake is within a factor, UF, of the nominal risk associated with the appropriate ICRP dose coefficient, E(50), with respect to uncertainties in the biokinetic model parameter values. Ingestion: it is assumed that exposure occurs through the ingestion of radionuclides present in food and water. The results for both radionuclides suggest a UF of within 3 for all age groups, with median values close to the ICRP values. Inhalation: it is assumed that environmental exposure to radium occurs primarily due to insoluble forms present in fly ash discharged from coal-fired power stations; for strontium, exposure is assumed to occur due to residual aerosols produced as a result of atmospheric nuclear testing and nuclear reactor accidents. The results suggest a UF of around 3 and 6 for inhalation of (90)Sr and (226)Ra, respectively, by members of the public.

A physiologically based pharmacokinetic model for strontium exposure in rat

PURPOSE

To develop a physiologically based pharmacokinetic (PBPK) model to describe the disposition of Strontium--a bone seeking agent approved in 2004 (as its Ranelate salt) for treatment of osteoporosis in post-menopausal women.

METHODS

The model was developed using plasma and bone exposure data obtained from ovariectomised (OVX) female rats--a preclinical model for post-menopausal osteoporosis. The final PBPK model incorporated elements from literature models for bone seeking agents allowing for description of the heterogeneity of bone tissue and also for a physiological description of bone remodelling processes. The model was implemented in MATLAB in open and closed loop configurations, and fittings of the model to exposure data to estimate certain model parameters were carried out using nonlinear regression, treating data with a naïve-pooled approach.

RESULTS

The PBPK model successfully described plasma and bone exposure of Strontium in OVX rats with parameter estimates and model behaviour in keeping with known aspects of the distribution and incorporation of Strontium into bone.

CONCLUSIONS

The model describes Strontium exposure in a physiologically rationalized manner and has the potential for future uses in modelling the PK-PD of Strontium, and/or other bone seeking agents, and for scaling to model human Strontium bone exposure.

Biokinetics of 90Sr after chronic ingestion in a juvenile and adult mouse model

The aim of our study was to define the biokinetics of (90)Sr after chronic contamination by ingestion using a juvenile and adult murine model. Animals ingested (90)Sr by drinking water containing 20 kBq l(-1) of (90)Sr. For the juvenile model, parents received (90)Sr before mating and their offspring were killed between birth and 20 weeks of ingestion. For the adult model, (90)Sr ingestion started at 9 weeks of age and they were killed after different ingestion periods up to 20 weeks. The body weight, food and water consumption of the animals were monitored on a weekly basis. Before killing and sampling of organs, animals were put in metabolic cages. (90)Sr in organs and excreta was determined by liquid scintillation β counting. Highest (90)Sr contents were found in bones and were generally higher in females than in males, and (90)Sr retention varied according to the skeletal sites. An accumulation of (90)Sr in the bones was observed over time for both models, with a plateau level at adult age for the juvenile model. The highest rate of (90)Sr accumulation in bones was observed in early life of offspring, i.e. before the age of 6 weeks. With the exception of the digestive tract, (90)Sr was below the detection limit in all other organs sampled. Overall, our results confirm that (90)Sr mainly accumulates in bones. Furthermore, our results indicate that there are gender- and age-dependent differences in the distribution of (90)Sr after low-dose chronic ingestion in the mouse model. These results provide the basis for future studies on possible non-cancerous effects during chronic, long-term exposure to (90)Sr through ingestion in a mouse model, especially on the immune and hematopoietic systems.

Reconstruction of (90)Sr intake for breast-fed infants in the Techa riverside settlements

The Techa River (Southern Urals, Russia) was contaminated as a result of radioactive releases by the Mayak plutonium production facility during 1949-1956. The persons born after the onset of the contamination have been identified as the "Techa River Offspring Cohort" (TROC). The TROC has the potential to provide direct data on health effects in progeny that resulted from exposure of a general parent population to chronic radiation. The purpose of the present investigation is the estimation of (90)Sr intake from breast milk and river water in the period from birth to 6 months of life, necessary for an infant dose calculation. The investigation is based on all available data concerning radioactive contamination due to global fallouts and Mayak releases in the Southern Urals where extensive radiometric and radiochemical investigations of human tissues and environmental samples were conducted during the second half of the twentieth century. The strontium transfer factor from mother's daily diet to breast milk was estimated as 0.05 (0.01-0.13) d L(-1). Based on this transfer factor and data on (90)Sr water contamination, the average total (90)Sr intake for an infant born in the middle Techa River region was found to be equal to 60-80 kBq in 1950-1951. For the same period, calculations of (90)Sr intake using ICRP models gave values of 70-100 kBq. From 1952 onwards, the differences in intakes calculated using the two approaches increased, reaching a factor of 2-3 in 1953. The Techa River data provide the basis for improving and adapting the ICRP models for application to Techa River-specific population.

Influence of human biokinetics of strontium on internal ingestion dose of 90Sr and absorbed dose of 89Sr to organs and metastases

The objective of the present work is to apply the plasma clearance parameters to strontium, previously determined in our laboratory, to improve the biokinetic and dosimetric models of strontium-90 ((90)Sr) used in radiological protection; and also to apply this data for the estimation of the radiation doses from strontium-89 ((89)Sr) after administration to patients for the treatment of the painful bone metastases. Plasma clearance and urinary excretion of stable strontium tracers of strontium-84 ((84)Sr) and strontium-86 ((86)Sr) were measured in GSF-National Research Center for Environment and Health (GSF) in 13 healthy German adult subjects after intravenous injection and oral administration. The biological half-life of strontium in plasma was evaluated from 49 plasma concentration data sets following intravenous injections. This value was used to determine the transfer rates from plasma to other organs and tissues. At the same time, the long-term retention of strontium in soft tissue and whole body was constrained to be consistent with measured values available. A physiological urinary path was integrated into the biokinetic model of strontium. Parameters were estimated using our own measured urinary excretion values. Retention and excretion of strontium were modeled using compartmental transfer rates published by the International Commission on Radiological Protection (ICRP), the SENES Oak Ridge Inc. (SENES), and the Urals Research Center for Radiation Medicine (TBM). The results were compared with values calculated by applying our GSF parameters (GSF). For the dose estimation of (89)Sr, a bone metastases model (GSF-M) was developed by adding a compartment, representing the metastases, into the strontium biokinetic model. The related parameters were evaluated based on measured data available in the literature. A set of biokinetic parameters was optimized to represent not only the early plasma kinetics of strontium but also the long-term retention measured in soft tissue and whole body. The ingestion dose coefficients of (90)Sr were computed and compared with different biokinetic model parameters. The ingestion dose coefficients were calculated as 2.8 x 10(-8), 2.1 x 10(-8), 2.5 x 10(-8) and 3.8 x 10(-8) Sv Bq(-1) for ICRP, SENES, TBM and GSF model parameters, respectively. Moreover, organ absorbed dose for the radiopharmaceutical of (89)Sr in bone metastases therapy was estimated based on the GSF and ICRP biokinetic model parameters. The effective doses were 3.3, 1.8 and 1.2 mSv MBq(-1) by GSF, GSF-M, and ICRP Publication 67 model parameters, respectively, compared to the value of 3.1 mSv MBq(-1) reported by ICRP Publication 80. The absorbed doses of red bone marrow and bone surface, 17 and 21 mGy MBq(-1) calculated by GSF parameters, and 7.1 and 8.8 mGy MBq(-1) by GSF-M parameters, are comparable to the clinical results of 3-19 mGy MBq(-1) for bone marrow and 16 mGy MBq(-1) for bone surface. Based on the GSF-M model, the absorbed dose of (89)Sr to metastases was estimated to be 434 mGy MBq(-1). The strontium clearance half-life of 0.25 h from the plasma obtained in the present study is obviously faster than the value of 1.1 h recommended by ICRP. There are no significant changes for ingestion dose coefficients of (90)Sr using different model parameters. A model including the metastases was particularly developed for dose estimation of (89)Sr treatment for the pain of bone metastases.

A review of strontium ranelate and its effect on DXA scans

Strontium ranelate is a new orally administered agent for the treatment of women with postmenopausal osteoporosis that reduces the risk of vertebral and nonvertebral fractures. This review article examines the evidence for the antifracture efficacy and safety of strontium ranelate treatment and discusses the effect of DXA scans, biochemical markers of bone turnover, and bone histology. In the SOTI trial, three years treatment with strontium ranelate led to a 41% reduction in vertebral fracture risk (relative risk [RR]=0.59; 95% CI: 0.48-0.73; p<0.001), while in the TROPOS study there was a 16% reduction in nonvertebral fractures (RR=0.84; 95% CI 0.702-0.995; p=0.04). Compared with alternative osteoporosis therapies, strontium ranelate treated patients show large increases in BMD coupled with comparatively modest changes in biochemical markers of bone turnover and bone histology. While the large BMD changes provide a useful way of monitoring patients' response to treatment, it is important to appreciate that much of the increase is a purely physical effect due to the increased attenuation of X-ray when some of the calcium in bone is replaced by strontium. Strontium ranelate is a useful addition to the range of antifracture treatments available for treating postmenopausal women with osteoporosis and is the only treatment proven to be effective at preventing both vertebral and nonvertebral fractures in women aged 80 yr and older.

Human biokinetics of strontium--part II: Final data evaluation of intestinal absorption and urinary excretion of strontium in human subjects after stable tracer administration

Fractional intestinal absorption (f1 value) and urinary excretion of strontium in healthy human volunteers has been measured by simultaneous oral and intravenous administration of the stable isotopes 86Sr and 84Sr using the double-isotope method. Final evaluation of the complete data set confirmed that ingestion of different foodstuff and nutritional factors could influence the fractional gut uptake of strontium. In some cases, significant deviations from the f1 value adopted by the International Commission on Radiological Protection (ICRP) were found. The arithmetic mean (+/- standard deviation) of the f1 values of all experiments performed was determined to be 0.46 (+/- 0.24). The probability distribution function of the f1 values is represented by a lognormal curve with a geometric mean of 0.38 and a geometric standard deviation of 2.06. Urinary excretion in all subjects varied depending on the administered foodstuff in a wide range and differs from the ICRP model, up to 2 days after tracer administration. No age or gender dependence of the absorbed strontium fraction and of the urinary excretion of strontium after an oral load was found.

Theoretical model for the interpretation of BMD scans in patients stopping strontium ranelate treatment

Strontium ranelate is a new treatment for osteoporosis that results in large increases in BMD, much of which is an artefact caused by high bone strontium content. We used clinical trial data and a model of long-term strontium kinetics to estimate the effect of past strontium treatment on future BMD measurements.

INTRODUCTION

The oral administration of strontium ranelate causes a clinically significant overestimation of BMD because of the high attenuation of X-rays by strontium atoms in bone. As more patients are treated with strontium ranelate, questions will arise about the correct interpretation of their future BMD measurements. We performed a theoretical study to calculate the long-term effect of strontium treatment on BMD and establish the duration of past treatment for which the remaining bone strontium content (BSC) has a negligible effect on BMD.

MATERIALS AND METHODS

The BMD changes measured at the spine and hip during strontium ranelate treatment were interpolated from clinical trial data. The long-term retention of strontium in bone was estimated using the International Commission on Radiological Protection (ICRP) strontium retention function modified for use in postmenopausal women. Estimates of the strontium BMD artefact after treatment has stopped were performed on the assumption that the BSC effect accounts for 75% of the total measured BMD change at 3 years.

RESULTS

If 75% of the BMD changes are explained by BSC, in the average patient, 3-year treatment leads to a spine BMD artefact of 11.2%, decreasing to 3.8% 10 years after stopping treatment. The BMD artefacts at the total hip and femoral neck sites are smaller by factors of 0.65 and 0.53, respectively. If pre- and post-therapy BMD measurements are available, these predictions can be tailored to the individual patient. On average, 6-month treatment is required for the spine BMD artefact to exceed 3%, the figure adopted as the maximum BMD change caused by bone strontium that has a negligible effect on scan interpretation. Ten years after stopping treatment, 28 months of treatment are required for the residual BMD artefact to still exceed the 3% threshold.

CONCLUSIONS

Strontium ranelate treatment lasting for >6 months can affect BMD measurements for many years afterward.

90Sr in deciduous teeth from 1950 to 2002: the Swiss experience

Switzerland has recorded the level of activity of 90Sr in the milk teeth of children from different regions of the country since the first atomic explosions in the atmosphere. Activity peaked at 0.421 Bq g-1 Ca at the beginning of the sixties, coinciding with the detonation of many large nuclear devices. Following the Nuclear Test Ban Treaty that ended atmospheric nuclear weapon tests, a steady and significant decrease in 90Sr activity in milk teeth has been observed-down to a value of 0.03 Bq g-1 Ca for children born in 1994. The apparent half-life of 90Sr in milk teeth is 9.8+/-3 years. With the exception of the period from 1962 to 1964, there is no correlation between the activity in the teeth of children born in a given year and the year of extraction. Between 1953 and 1992, the milk teeth of children born in Zürich county showed 16% less activity than teeth from children born in Vaud county. Dairy consumption habits might be responsible for this trend. The effect of the 90Sr deposition from Chernobyl is barely measurable in milk teeth, and no effect is seen from the five Swiss nuclear reactors. This paper emphasizes the necessity of a very high purity chemical separation of 90Sr or 90Y to determine 90Sr activity in milk teeth or other samples.

Human biokinetics of strontium. Part I: intestinal absorption rate and its impact on the dose coefficient of 90Sr after ingestion

Intestinal absorption of strontium (Sr) in thirteen healthy adult German volunteers has been investigated by simultaneous oral and intravenous administration of two stable tracer isotopes, i.e. (84)Sr and (86)Sr. The measured Sr tracer concentration in plasma was analyzed using the convolution integral technique to obtain the intestinal absorption rate. The results showed that the Sr labeled in different foodstuffs was absorbed into the body fluids in a large range of difference. The maximum Sr absorption rates were observed within 60-120 min after administration. The rate of absorption is used to evaluate the intestinal absorption fraction, i.e. the f (1) value for various foodstuffs. The equivalent and effective dose coefficients for ingestion of (90)Sr were calculated using these f (1) values, and they were compared with those recommended by the International Commission on Radiological Protection (ICRP). The geometric and arithmetic means of the f (1) values are 0.38 and 0.45 associated with a geometric standard deviation and a standard deviation of 1.88 and 0.22, respectively. The 90% confidence interval of the f (1) values obtained in the present study ranges from 0.13 to 0.98. Expressed as the ratio of the 95 and 50% percentiles of the estimated probability, the uncertainty for the f (1) value corresponds to a factor of 2.58. The effective dose coefficients of (90)Sr after ingestion are 6.1 x 10(-9) Sv Bq(-1) for an f(1) value of 0.05, 1.0 x 10(-8) Sv Bq(-1) for 0.1, 1.9 x 10(-8) Sv Bq(-1) for 0.2, 2.8 x 10(-8) Sv Bq(-1) for 0.3, 3.6 x 10(-8) Sv Bq(-1) for 0.4, 5.3 x 10(-8) Sv Bq(-1) for 0.6, 7.1 x 10(-8) Sv Bq(-1) for 0.8, and 7.9 x 10(-8) Sv Bq(-1) for 0.9, respectively. Taking the effective dose coefficient of 2.8 x 10(-8) Sv Bq(-1) for an f (1) value of 0.3, which is recommended by the ICRP, as a reference, the effective dose coefficient of (90)Sr after ingestion varies by a factor of 2.8 when the f (1) value changes by a factor of 3, i.e. it decreases from 0.3 to 0.1 or increases from 0.3 to 0.9, respectively.

Methods for assessing gastrointestinal absorption of strontium in humans by stable tracer techniques

Intestinal absorption of strontium from an oral test dose was studied in 13 healthy human volunteers using double tracer techniques with two stable strontium isotopes as tracers. Defined amounts of one isotope were administered orally, while tracer amounts of the second isotope were injected intravenously. Two different methods were used to assess the total fraction absorbed (f1 value). Fractional intestinal strontium absorption can be calculated from the ratio of the two isotopes in plasma or urine samples (in this paper called the double-isotope method) or the convolution integral technique, since both methods provide an accurate estimate of fractional absorption and yield comparable results. The latter additionally provides information on the absorption kinetics in the gastrointestinal tract. The absorption varies with respect to the chemical form and to the amount administered. Absorption patterns are characteristically different for uptake from solutions or from whole meals.

Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy

Strontium ranelate is a new orally administered agent for the treatment of women with postmenopausal osteoporosis that reduces the risk of vertebral and hip fractures. Evidence for the safety and efficacy of strontium ranelate comes from two large multinational trials, the SOTI (Spinal Osteoporosis Therapeutic Intervention) and TROPOS (Treatment Of Postmenopausal Osteoporosis) studies. The SOTI study evaluated vertebral fracture prevention in 1649 postmenopausal women with a mean age of 69 y. The subjects all had at least one previous vertebral fracture and a low spine bone mineral density (BMD) (equivalent to a Hologic spine T-score below -1.9). The strontium ranelate group had a 41% lower risk of a new vertebral fracture than the placebo group over the three-year study period (relative risk [RR] = 0.59; 95% confidence interval [CI]: 0.48-0.73; p < 0.001). The TROPOS study evaluated non-vertebral fracture prevention in 5091 postmenopausal women with a mean age of 77 y. The subjects were aged 74 y and over (or 70-74 y with one additional risk factor) and a low femoral neck BMD (equivalent to an NHANES III [Third National Health and Nutrition Examination Survey] T-score below -2.2). Over the three-year study period there was a 16% reduction in all non-vertebral fractures (RR = 0.84; 95% CI 0.702-0.995; p = 0.04) and a 19% reduction at the principal sites for non-vertebral fractures. The TROPOS study was not powered to investigate hip fracture risk. However, in a high risk group of women aged 74 y and over and with an NHANES III femoral neck T-score less than -2.4 there was a 36% reduction in hip fracture risk (RR = 0.64; 95% CI: 0.412-0.997; p = 0.046). The overall incidence of adverse events did not differ significantly from placebo and were generally mild and transient, the most common being nausea and diarrhea. Strontium ranelate is a useful addition to the range of anti-fracture treatments available for treating postmenopausal women with osteoporosis and is the only treatment proven to be effective at preventing both vertebral and hip fractures in women aged 80 y and over.

Difficulty in dislodging in vivo fixed radiostrontium

Many trials based on the basic phenomena of isotopic dilution, adsorption, ion exchange, chelation, etc., have been attempted for the decorporation of radiostrontium, particularly Sr, after its entry in the in vivo system. We have recently demonstrated a non-isotopic carrier effect of some common calcium salts (calcium = 9 mg mL) to reduce the whole body retention of radiostrontium, if administered within 2 h after radiostrontium exposure and furthermore once daily, in rats, supplemented with calcium fortified diet. However, 25-30% of radiostrontium (compared to 50-60% in untreated animals) was still found to be retained in the animal even after 2 wk of treatment. Trial of some simple interventional measures, which would not adversely affect the animal metabolism, like pyrophosphate and magnesium sulfate, sodium citrate, chitin (a bio-absorbent), crown ether (a metal-chelator), and ammonium chloride, was therefore attempted to dislodge this remaining radiostrontium by switching over these animals to normal diet and subjecting them to different lines of treatment with these simple interventions through diet and drinking water separately for a further 4 wk. However, this remaining portion of radiostrontium is fixed in the bone and is difficult to dislodge.

Uncertainties in dose coefficients from ingestion of 131I, 137Cs, and 90Sr

Quantification of uncertainties in doses from intakes of radionuclides is important in risk assessments and epidemiologic studies of individuals exposed to radiation. In this study, the uncertainties in the doses per unit intake (i.e., dose coefficients) for ingestion of 131I, 137Cs, and 90Sr by healthy individuals have been determined. Age-dependent thyroid dose coefficients were derived for 131I. The analysis for 131I uses recent measurements of thyroid volume obtained by ultrasonography, which indicate a thyroid mass lower than that previously obtained using autopsy measurements. The coefficients for 137Cs are determined using the relationship between the biological half-lives and the amount of potassium in the human body. The most recent International Commission on Radiological Protection biokinetic model was employed to determine the uncertainties for 90Sr. For 137Cs and 90Sr, the dose coefficients represent exposure in adulthood and they were determined for all organs of radiological importance. The uncertainty in the estimated dose coefficients represent state of knowledge estimates for a reference individual, and they are described by lognormal distributions with a specified geometric mean (GM) and geometric standard deviation (GSD). The estimated geometric means vary only slightly from the dose coefficients reported by ICRP publications. The largest uncertainty is observed in the dose coefficients for bone surface (GSD = 2.6), and red bone marrow (GSD = 2.4) in the case of ingestion of 90Sr. For most other organs, the uncertainty in the 90Sr dose coefficients is characterized by a GSD of 1.8 (or less for some organs). For 131I, the uncertainty in the thyroid dose coefficients is well represented by a GSD of 1.7 for both sexes and all ages other than infants for whom a GSD of 1.8 is more appropriate. The lowest uncertainties are obtained for the dose coefficients from ingestion of 137Cs (GSD = 1.24 for males; 1.4 for females). A dominant source of uncertainty in the ingestion dose coefficients is the variation of the biokinetic parameters. For 131I, the largest contribution to the uncertainty comes from the variation in the thyroid mass, but the contribution of the biokinetic parameters is comparable. The biokinetic parameters with the largest contribution to the uncertainty are (a) the fractional uptake from blood to thyroid in the case of ingestion of 131I, (b) the absorbed fraction from the gastrointestinal tract (f1) in the case of 90Sr, and (c) the amount of potassium in the body for 137Cs. The contribution to the uncertainty of the absorbed fraction (which accounts for the fraction of energy deposited in the target organ) is the smallest contributor to the uncertainty in the dose coefficients for most organs. To reduce the uncertainty in the dose estimated for a real individual, one should determine the above-mentioned parameters for the specified individual rather than to rely on assumptions for a reference individual.