# Bone Support and Protocol Notes

### McKinney's bone support perspective

This section draws heavily on Dr Neil McKinney's *Naturopathic Oncology*.

Key points highlighted here include:

* regular exercise matters for maintaining and improving bone health
* **microcrystalline hydroxyapatite** can build bone density and mass more rapidly than bisphosphonate drugs in this interpretation
* unlike bisphosphonates, it is presented as supporting new bone formation rather than mainly slowing bone loss
* calcium supplements may matter less than vitamin D3, vitamin K2, regular exercise, and strontium in broader bone-health strategy
* **strontium citrate** has evidence for reducing fracture risk and should be taken separately from calcium because they compete for absorption
* a practical dose for low bone density is given here as two 340 mg capsules of strontium citrate at bedtime, paired with vitamin K2
* there is also caution around stroke-risk debates extrapolated from prescription strontium ranelate data, and around bone-density scans overstating density in people using strontium
* if hormone-therapy resistance develops, mTOR inhibitors such as everolimus may enter discussion, with indole-3-carbinol, green tea EGCG, and curcumin also noted as natural compounds with mTOR-related relevance

### Reference

Naturopathic Oncology, Fourth Edition\
<https://www.drneilmckinney.ca/product/naturopathic-oncology-fourth-edition/>

### Practitioner protocol notes

#### Strontium and calcium timing

Strontium should be taken separately from calcium supplements and calcium-rich foods.

Calcium competes with strontium for intestinal absorption.

A 2- to 4-hour gap is generally recommended here.

Strontium ranelate guidance is also cited in support of avoiding calcium at bedtime when using strontium.

[Strontium ranelate guidance](https://theros.org.uk/information-and-support/osteoporosis/treatment/strontium-ranelate/)

#### Ossopan 1100 timing

Microcrystalline hydroxyapatite is positioned here as best taken just after dinner.

The reasoning given is alignment with nocturnal bone remodelling and osteoblast activity.

More information and typical dosing were linked here:

[Hydroxyapatite and bone health](https://slowaging.org/hydroxyapatite-aging-bone-health/)

*Availability note: this product appears easier to source in the USA and Canada than in some other regions.*

#### RegeneMax Plus timing

RegeneMax Plus is positioned here for bedtime use.

The rationale given is support for collagen synthesis and bone flexibility through choline-stabilised orthosilicic acid and biotin.

*Availability note: this product also appears easier to source in the USA and Canada.*

#### Protocol timing summary

| Supplement        | Timing                                                       | Key reason                             |
| ----------------- | ------------------------------------------------------------ | -------------------------------------- |
| Strontium citrate | Away from calcium, with a 2- to 4-hour gap, often at bedtime | Prevents absorption competition        |
| Ossopan 1100      | Just after dinner                                            | Supports nocturnal bone mineralisation |
| RegeneMax Plus    | Bedtime                                                      | Supports collagen synthesis timing     |

#### Great Bones

**Great Bones** by R. Keith McCormick is recommended here as a science-backed guide to osteoporosis management, lab testing, and bone-health planning.

[Great Bones books and resources](https://greatbonesconsulting.com/books/)

### Implementation notes

These notes were presented as study notes rather than clinical advice.

* **Strontium dosing:** 340 to 680 mg strontium citrate at bedtime, at least 2 hours after dinner
* **Calcium alternatives:** prioritise hydroxyapatite over carbonate or citrate forms in this interpretation
* **Circadian alignment:** nighttime dosing of bone-supporting supplements is framed as matching peak osteoblast activity
* **Infusion timing:** extending Zometa infusion to 30 minutes may reduce acute reactions
* **Dose interval:** raising the question of 12-weekly Zometa dosing with an oncologist may be reasonable when relevant
* **Support networks:** online groups may help with lived-experience questions around Xgeva and Zometa side effects

### Personalise and check safety

The main practical caution points are:

* tailor interventions to cancer subtype, drug regimen, SNP pattern, and metabolic profile
* monitor calcium and vitamin D regularly
* review all supplements and off-label agents for drug interactions before use

### Bone Metastases in Breast Cancer pages

* [Bone Metastases in Breast Cancer](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer.md)
* [Xgeva and Zometa](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer/xgeva-and-zometa.md)
* [Integrative and Off-Label Strategies](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer/integrative-and-off-label-strategies.md)
* [FOXM1 in Bone Metastasis](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer/foxm1-in-bone-metastasis.md)
* [Bone Support and Protocol Notes](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer/bone-support-and-protocol-notes.md)
* [Group Member Tips and Supporting Evidence](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer/group-member-tips-and-supporting-evidence.md)

### Also relevant

* [SABR for BC Bone Mets 2025 Study Summary](/myhealingcommunity-docs/breast-cancer/metastatic-disease-support/bone-metastases-in-breast-cancer/sabr-for-bc-bone-mets-2025-study-summary.md)


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