Highlights

• Holmium is a crucial rare earth element enabling precision medical technologies like surgical lasers and cancer therapies.
• Over 90% of holmium oxide is refined in China, creating significant supply chain vulnerabilities for medical device manufacturers.
• Strategic diversification of suppliers and alternative technologies like thulium fiber lasers are essential for maintaining medical technology continuity.

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An available rare earth element where processing in the bottleneck

While neodymium and dysprosium dominate headlines in the rare earths sector, holmium (Ho) quietly enables life-saving medical technologies that millions rely on annually. This heavy rare earth element, often overlooked even within specialized circles, is the backbone of precision surgical lasers and advanced cancer therapies. Without holmium, the landscape of minimally invasive surgery would look drastically different. 

The Critical Role of Holmium in Medicine

Holmium’s unique properties make it indispensable in healthcare. As the key component in holmium-doped yttrium aluminum garnet (Ho:YAG) crystals, it forms the core of lasers operating at a 2.1-micron wavelength—a sweet spot for medical applications. At this wavelength, the laser energy is strongly absorbed by water, allowing surgeons to ablate or fragment tissue with exceptional precision. This characteristic has made Ho:YAG lasers the gold standard for: 

• Kidney stone removal (lithotripsy): Breaking down calculi without damaging surrounding tissue. 
• Prostate treatments: Minimally invasive procedures for benign prostatic hyperplasia. 
• ENT and orthopedic surgeries: Delicate operations on soft tissues and bone.

Beyond lasers, holmium-166 (Ho-166) radioisotopes are used in targeted cancer therapies, particularly for liver tumors via microsphere embolization. These tiny radioactive beads deliver localized radiation, sparing healthy tissue. 

Supply Chain Vulnerabilities

Despite being more abundant in Earth’s crust than silver, holmium’s "rarity" stems from its complex extraction and processing. Over 90% of the world’s holmium oxide is refined in China, creating a single point of failure. Even if mined elsewhere, such as Australia, Myanmar, or the U.S., heavy rare earth ores typically flow to Chinese facilities for separation. Medical-grade holmium requires ultra-high purity, further concentrating processing capacity in specialized hubs. A disruption in Chinese supply chains, whether from geopolitical tensions, export restrictions, or logistical delays, could halt global Ho:YAG crystal production within months. 

Emerging Alternatives and Mitigation Strategies 

The medical device industry is not without options: 

1. Non-Chinese Refining and Crystal Growth:

• U.S.-based Heeger Materials and MSE Supplies produce medical-grade Ho:YAG crystals, though they depend on imported feedstock. 
• Belgium’s Sinoptix offers precision optical crystals with coatings ready for surgical use.

  Key challenge: Reliance on Chinese-sourced holmium oxide remains a bottleneck. 

2. Technological Shifts: 

 Thulium fiber lasers (TFLs) are gaining traction in urology. Operating at a 1.94-micron wavelength, TFLs rival Ho:YAG in precision while leveraging existing fiber laser infrastructure, which is more geographically distributed. However, thulium, another Chinese-dominated heavy rare earth, introduces similar supply risks. 

3. Proactive Risk Management

To safeguard holmium crystal supply and ensure uninterrupted operations, companies should diversify suppliers by qualifying multiple crystal vendors across different regions before disruptions occur, and secure feedstock by partnering with emerging non-Chinese refiners such as Australia’s Lynas or Iluka Resources. Strategic stockpiling is also key—maintaining buffers of holmium oxide and finished crystals is feasible given the small volumes required. In parallel, developing TFL systems can provide surgeons with alternative options if holmium supply falters. Finally, organizations should actively monitor Chinese export licenses and quota policies to gain early warning of potential restrictions and act before the market tightens.

Why Holmium Deserves Attention

Holmium’s impact extends beyond niche applications. A supply disruption could delay surgeries, worsen patient outcomes, and force hospitals to adopt less optimal alternatives. For device manufacturers, it underscores the need for resilient sourcing and R&D investment in substitutes. 

While holmium may never rival neodymium in market size, its role in healthcare is irreplaceable—for now. Proactive vigilance, not complacency, will ensure this unsung rare earth continues saving lives.