Intestinal Strontium Absorption Research Articles

BIOMATERIALS FOR THE DECORPORATION OF 85Sr IN THE RAT

Although four stable isotopes of strontium occur naturally, Sr is produced by nuclear fission and is present in surface soil around the world as a result of fallout from atmospheric nuclear weapons tests. It can easily transfer to humans in the event of a nuclear/radiological emergency or through the plant-animal-human food chain causing long-term exposures. Strontium is chemically and biologically similar to calcium, and is incorporated primarily into bone following internal deposition. Alginic acid (alginate) obtained from seaweed (kelp) extract selectively binds ingested strontium in the gastrointestinal tract blocking its systemic uptake and reducing distribution to bone in rats, while other natural polysaccharides including chitosan and hyaluronic acid had little in vivo affinity for strontium. Alginate exhibits the unique ability to discriminate between strontium and calcium and has been previously shown to reduce intestinal absorption and skeletal retention of strontium without changing calcium metabolism. In our studies, the effect of commercially available alginate on intestinal absorption of strontium was examined. One problem associated with alginate treatment is its limited solubility and gel formation in water. The aqueous solubility of sodium alginate was improved in a sodium chloride/sodium bicarbonate electrolyte solution containing low molecular weight polyethylene glycol (PEG). Furthermore, oral administration of the combined alginate/electrolyte/PEG solution accelerated removal of internal strontium in rats when compared to treatment with individual sodium alginate/electrolyte or electrolyte/PEG solutions. Importantly, both alginate and PEG are nontoxic, readily available materials that can be easily administered orally in case of a national emergency when potentially large numbers of the population may require medical treatment for internal depositions. Our results suggest further studies to optimize in vivo decorporation performance of engineered alginate material via modification of its chemical and physicochemical properties are warranted.

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.

Intestinal calcium absorption is associated with bone mass in stone-forming women with idiopathic hypercalciuria

Background: Patients with idiopathic hypercalciuria are predisposed to osteoporosis despite their high enteral calcium absorption. Conversely, low calcium absorption has been reported in patients with osteoporosis. Because bone loss occurs earlier in women, this work explores the relationship between bone mineral density (BMD) and calcium absorption in premenopausal and postmenopausal hypercalciuric stone-forming women. Methods: BMD and intestinal calcium absorption were compared in 64 hypercalciuric and 42 normocalciuric calcium stone-forming women. Calcium absorption was assessed by using strontium as a surrogate marker for calcium. Strontium was administered to patients as an oral load, then measured in blood to calculate absorption after 60 minutes. Femoral and lumbar-spine BMD were measured by dual-energy x-ray absorptiometry. Results: Strontium absorption was significantly increased in hypercalciuric stone formers, whereas BMD z score was decreased in hypercalciuric patients at the lumbar spine, but not the femur. The increase in strontium absorption was detected in both postmenopausal (n = 29) and premenopausal (n = 35) hypercalciuric patients. The decrease in lumbar-spine BMD was confirmed in postmenopausal, but not premenopausal, hypercalciuric patients. Strontium absorption was greater in hypercalciuric patients with a lumbar-spine BMD z score of −2 or less (n = 10) than in those with a score greater than −2 (n = 54). Multiple stepwise regression showed that lumbar-spine BMD was related negatively to intestinal strontium absorption and age in hypercalciuric patients. Conclusion: Results of the strontium absorption test suggest that the increase in calcium absorption is associated with a decrease in lumbar-spine BMD in hypercalciuric stone-forming women. Hypercalciuric stone-forming women with high calcium intestinal absorption denote a group of patients predisposed to loss of bone mass.

Vitamin D receptor gene BsmI-polymorphism in Finnish premenopausal and postmenopausal women: its association with bone mineral density, markers of bone turnover, and intestinal calcium absorption, with adjustment for lifestyle factors.

Bone mineral density (BMD) is regulated by genetic and environmental factors. Sixty percent to 80% of bone mass is suggested to be under polygenetic control, but the role of individual genes seems to be modest. Several studies have indicated that the vitamin D receptor ( VDR) gene has a role in the regulation of BMD and bone metabolism, but the results are very controversial. We studied the associations between BsmI-polymorphism of the VDR gene and BMD and bone metabolism in 24 premenopausal (aged 22-45 years) and 69 postmenopausal (aged 48-65 years) Finnish women. The BMD of the lumbar spine and femoral neck and bone turnover markers were measured, and the intestinal calcium absorption was investigated, using a method based on the absorption of non-radioactive strontium. The genotype distribution was 16%, BB; 34.5%, Bb; and 49.5%, bb, which differs from the genotype distribution found in other Caucasian populations, but is similar to earlier Finnish reports. The winter value of 25-hydroxyvitamin-D (25-OH-D) was highest for the BB genotype in both age groups (analysis of covariance [ANCOVA]; premenopausal women P = 0.5, postmenopausal women P = 0.03, and for the groups combined P = 0.02). Lumbar spine BMD and intestinal strontium absorption were highest for the BB genotype in both age groups, but these results were nonsignificant. The markers of bone metabolism did not differ significantly between the VDR genotypes. The BB genotype had the best vitamin D status, which could explain the differences in calcium absorption between the genotypes. However, the conclusions of our study are limited because of the small number of subjects.

Effect of estrogen on intestinal strontium absorption in postmenopausal women

Objectives: there is considerable uncertainty about the underlying cause of decreased intestinal calcium absorption that occurs in postmenopausal women. In a previous study, estrogen treatment did not result in an increased intestinal calcium absorption using strontium as a marker. A possible explanation could be that the calcium/strontium load given to the women was too high (∼600 mg Ca), which might result in an insensitive test with respect to the possible stimulation of active strontium transport by estrogen. Therefore, the purpose of this study was to reinvestigate the effect of estrogen on active intestinal strontium absorption using a load of 2.5 mmol of strontium only. Methods: the effect of estrogen on intestinal strontium absorption was measured in eight normal postmenopausal women. The study included two baseline strontium absorption tests, which were performed with an interval of 10 days for calculating the within subject variation (SER). Thereafter the effect of 2 months of estrogen treatment on intestinal strontium absorption was assessed. Fractional absorption (FC 240) and the area under the concentration time curve (AUC) 4 h after an oral strontium load of 2.5 mmol were calculated. Results: the within subject SER of FC 240 and AUC 0-240 were 2.3±0.76 and 1.2±0.41, respectively. FC 240 and AUC 0-240 of strontium were unchanged after treatment with estrogen. Conclusions: in normal postmenopausal women, we did not find a modulating effect of short-term treatment with a (supra) physiological dose of estrogen on intestinal calcium absorption as measured by the strontium absorption test.

No difference in intestinal strontium absorption after oral or IV calcitriol in children with secondary hyperparathyroidism

Oral and intravenous calcitriol bolus therapy are both recommended for the treatment of secondary hyperparathyroidism, but it has been claimed that the latter is less likely to induce absorptive hypercalcemia. The present study was undertaken to verify whether intravenous calcitriol actually stimulates intestinal calcium absorption less than oral calcitriol and whether it is superior in suppressing parathyroid hormone (PTH) secretion. Twenty children (16 males, age range of 5.1 to 16.9 years, mean creatinine clearance 21.9 +/- 11.5 mL/min/1.73 m2, range of 7.4 to 52.7) with chronic renal failure (CRF) and secondary hyperparathyroidism [median intact PTH (iPTH), 327 pg/mL; range 143 to 1323] received two single calcitriol boli (1.5 mg/m2 body surface area) orally and intravenously using a randomized crossover design. iPTH and 1,25(OH)2D3 levels were measured over 72 hours, and intestinal calcium absorption was measured 24 hours after the calcitriol bolus using stable strontium (Sr) as a surrogate marker. Baseline control values for Sr absorption were obtained in a separate group of children with CRF of similar severity. The peak serum level of 1,25(OH)2D3 and area under the curve baseline to 72 hours (AUC0-72h) were significantly higher after intravenous (IV) calcitriol (AUC0-72h oral, 1399 +/- 979 pg/mL. hour vs. IV 2793 +/- 1102 pg/mL. hour, P < 0.01), but the mean intestinal Sr absorption was not different [SrAUC0-240min during the 4 hours after Sr administration 2867 +/- 1101 FAD% (fraction of the absorbed dose) vs. 3117 +/- 1581 FAD% with oral and IV calcitriol, respectively]. The calcitriol-stimulated Sr absorption was more then 30% higher compared with control values (2165 +/- 176 FAD%). A significant decrease in plasma iPTH was noted 12 hours after the administration of the calcitriol bolus, which was maintained for up to 72 hours without any differences regarding the two routes of administration. These results demonstrate that under acute conditions, intravenous and oral calcitriol boli equally stimulate calcium absorption and had a similar efficacy in suppressing PTH secretion.

Strontium as a Marker for Intestinal Calcium Absorption: The Stimulatory Effect of Calcitriol

Intestinal strontium absorption is becoming accepted as a clinical and diagnostic tool for assessing intestinal calcium absorption in humans. However, little is known about whether intestinal strontium absorption, like that of calcium, is stimulated by calcitriol in healthy humans. The effect of calcitriol on intestinal strontium absorption was measured in eight healthy men, ages 20-60 years. Before administration of calcitriol, two tests were performed with an interval of 10 days for calculating the within-subject variation (SE(R)). Before the third test, 0.5 microg of calcitriol was given twice daily for 3 days. In each test, the fractional strontium absorption (Fc(240)) and the area under the concentration-time curve (AUC(0-240)) 4 h after an oral strontium load of 2.5 mmol were calculated. The within-subject SE(R) of Fc(240) and AUC(0-240) was 1.7 +/- 0.7 and 0.83 +/- 0.1, respectively. The stimulatory effect of calcitriol on Fc(240) and AUC(0-240) was 35% (21.8 +/- 2.0 to 28.8 +/- 2.4; P = 0.003) and 61% (8.97 +/- 0.97 to 14.4 +/- 1.3 mmol. L(-1). min; P = 0.001), respectively. Although the reproducibility of AUC(0-240) and its sensitivity to calcitriol were better than those of Fc(240), the Fc(240) of strontium is preferred for a clinical test because of its simplicity, requiring only two instead of five blood samples.

Preclinical screening of the applicability of strontium as a marker for intestinal calcium absorption.

The applicability of stable strontium as a marker for measuring intestinal calcium absorption is mainly dependent on the validity of the assumption that calcium and strontium are absorbed with a constant ratio. Up to now, it is not clear whether this ratio is affected by intervention therapy. Therefore, preclinical screening of this ratio before and after treatment is indispensable for a clinical calcium absorption test based on the use of stable strontium as a marker. We studied the effects of 1,25-dihydroxyvitamin D3 [1,25(OH)2D(3)], a potent enhancer of active intestinal calcium absorption, on the pharmacokinetics of both calcium-45 and strontium in adult male rats, in a short-term dose-finding study [0-50 ng 1,25(OH)2D(3)/100 g body weight] and also in a placebo-controlled study in which 12.5 ng 1,25(OH)2D(3)/100 g body weight were applied to assess the long-term pharmacokinetics. The mean bioavailability (true absorption) was 33% for calcium and 19% for strontium (ratio 1.7:1), whereas, after 1,25(OH)2D(3) pretreatment, it was 73 and 43% (ratio 1.7:1), respectively. These findings demonstrate that intestinal strontium absorption has, like intestinal calcium absorption, an active component. Moreover, they underscore the applicability of stable strontium as a tool for investigating calcium absorption under various conditions.

The effects of stable strontium on calcium metabolism: I. Kinetic analysis of calcium metabolism in strontium-fed rats

Stable strontium has been shown to inhibit the synthesis of 1α,25-dihydroxyvitamin D3(1,25(OH)2D3). In the present study, the effects of stable strontium on calcium metabolism were studied in growing rats. The rats were divided into control, 0.5%-Sr and 1.0%-Sr groups. After dietary treatment for 4 weeks, both intestinal calcium absorption (Vna) and the calcium absorption ratio (β) were suppressed dose-dependently by strontium. In contrast, while intestinal strontium absorption (sVna) was higher in the 1.0%-Sr group than that in the 0.5%-Sr group, there was no change in the strontium absorption ratio in the intestine (sβ). Although bone formation (Vo+) and bone resorption (Vo−) were both decreased in the strontium groups, no change was observed in the serum calcitonin and parathyroid hormone concentrations in the 1.0%-Sr group. Furthermore, a large amount of strontium deposited in newly formed bone. These results suggest that 1) the decrease of intestinal calcium absorption is due to either the reduction of 1,25(OH)2D3 synthesis or the competitive antagonistic action between calcium and strontium in the intestine, and 2) accumulation of a large amount of strontium in bone might directly inhibit bone formation and resorption.

Calcitropic Hormone Levels in Polynesians: Evidence against Their Role in Interracial Differences in Bone Mass*

Blacks are known to have a higher bone mass than whites and have recently been found to have significantly different levels of calcitropic hormones and other biochemical indices of calcium metabolism. To assess the possible significance of these biochemical differences to interracial differences in bone mass, we have undertaken an assessment of indices of calcium metabolism in Polynesian subjects, since they also have a higher bone mass than whites. Serum concentrations of 25-hydroxyvitamin D were slightly lower in Polynesians than in whites (65 +/- 5 vs. 95 +/- 10 nmol/L; P less than 0.02), but there were no differences between the groups in serum levels of calcium (total and ionized), phosphate, magnesium, 1,25-dihydroxyvitamin D, PTH, calcitonin, alkaline phosphatase activity, and bone gla-protein. Furthermore, urinary excretion of hydroxyproline, calcium, phosphate, magnesium, sodium, and potassium and the tubular maximum for the reabsorption of phosphate were not different between whites and Polynesians. Intestinal strontium absorption was similar in the two groups. In contrast, distal forearm bone mineral content was higher in Polynesians (P less than 0.01) and midupper arm muscle area was also increased in this group (P less than 0.005). It is concluded that the higher bone mass of Polynesians cannot be attributed to alterations in the basal levels of calcitropic hormones, but may be related to their greater muscle mass. It is probable that the previously observed black-white differences in the vitamin D endocrine system are secondary to the effects of skin color on vitamin D synthesis and are not contributory to the lower bone mass of whites.

Prophylaxis against vitamin D deficiency in the elderly by regular sunlight exposure.

The effects of regular sunlight exposure on levels of vitamin D metabolites and on other indices of calcium metabolism have been studied in elderly rest-home residents. Fifteen subjects who formerly went outdoors very infrequently were studied over a 4-week period while spending 0, 15 or 30 minutes daily sitting on the rest-home verandah. During this time, levels of 25-hydroxyvitamin D [25(OH)D] rose by 7.4 +/- 1.2 (s.e.m.) microgram/1 in the group spending 30 minutes per day outdoors (P less than 0.005) and there was a smaller but nonsignificant increase in the 15 minutes per day group also. Serum 1,25 (OH)2D levels did not change during the study but serum ionized calcium and alkaline phosphatase showed small, but significant, decreases. Intestinal strontium absorption increased in both treatment groups (P less than 0.05), indicating a similar change in calcium absorption. It is concluded that 30 minutes spent outdoors each day leads to a substantial increase in 25(OH)D levels in elderly subjects and that this has significant effects upon other indices of calcium metabolism. This regimen provides a safe and inexpensive method for the prevention of osteomalacia in frail elderly subjects.

Effects of experimental diabetes on intestinal strontium absorption in the rat.

Control and streptozotocin diabetic rats were studied at 5 and 12 days after induction of diabetes. Strontium absorption was measured by in situ perfusion of duodenum and ileum. Duodenal absorptive capacity (absorption per unit length) and absorptive specific activity (absorption per gram of dry weight mucosa) were depressed. Depression was present both at 5 days, when mucosal growth is similar in controls and diabetics, and at 12 days, when mucosal growth is 50% greater in diabetics. Effects of diabetes on ileal absorption were minimal in comparison with effects on duodenum. This depression of duodenal strontium absorption in the diabetic rat is analogous to effects of diabetes on calcium absorption and may be mediated by abnormal vitamin D metabolism.

Binding of calcium and strontium by alginates.

SODIUM alginates markedly inhibit the intestinal absorption of strontium in rats1–4 and man5,6 without an appreciable effect on calcium absorption so that they are of interest as possible therapeutic agents in cases of ingestion of strontium-90. Alginic acid is obtained from certain seaweeds and is a polymer of D-mannuronic acid and L-guluronic acid7 joined by 1,4 linkages8. It has been shown that guluronic-rich fractions of alginate are the most effective in reducing strontium absorption in rats in vivo and in vitro4,9.

Inhibiton of strontium and calcium uptake by rat duodenal slices: comparison of polyuronides and related substances.

IT has been established that intestinal absorption of strontium is inhibited by sodium alginate taken orally, both in the rat1–3 and in man4,5, while calcium absorption is not significantly reduced. Alginic acid is a polyuronide composed of L-guluronic and D-mannuronic acid residues6; both acids can occur in the same uronide chain7. Polygalacturonic acid was also found to inhibit the absorption of strontium more than that of calcium, when given to rats by stomach tube8. The effect of polyuronides other than alginate and polygalacturonate on the intestinal absorption of strontium has not been ascertained.

Discrimination in intestinal absorption of strontium and calcium.

Absorption of Sr/sup 85/ and Ca/sup 45/ was studied in the rat by the technique of in vivo intestinal perfusion. With no calcium added to the perfusion solution the percentage of Sr/sup 85/ absorbed was about 0.3 that of Ca/ sup 45/. With increasing levels of calcium in the perfusion solution, the percentage of Sr/sup 85/ and Ca/sup 45/ absorbed decreased; however, the ratio of percentage absorption of Sr/sup 85/ to Ca/sup 45/ increased, reaching a value of about 0.6 in 25 mmcalcium solution. There was no evidence of discrimination in the reverse movement of Sr/sup 85/ and Ca/sup 45/ from blood to intestine. The discrimination which ocours in the absorption process would appear to be a dominant factor in determining over-all strontium calcium relationships. (auth)