[Research on the relationship between populations' long-term exposure to fluoride in drinking water and bone fracture in China]

There are contradictory reports on the prevalence of bone fractures associated with long-term fluoride exposure from drinking water. The prevalence of bone fracture in six rural areas of China and the exposure of fluoride in drinking water was investigated. The data including medical history and demographic information, bone fractures, fluoride content in drinking water, physical activity, cigarette smoking, alcohol consumption and dietary intakes were collected. A retrospective epidemiological study by using the same design, method, quality control and the same questionnaire was conducted. A total of 8266 male and female over 50 years of age were divided into 6 groups by the fluoride concentrations in drinking water. The subjects in each group exposed to different levels of fluoride (0.25-0.34, 0.58-0.73, 1.00-1.06, 1.45-2.19, 2.62-3.58 and 4.32-7.97 mg/L) were 1363, 1407, 1370, 1574, 1051 and 1501 respectively. It has been confirmed that drinking water was the only major source of fluoride exposure in the studied populations. The total bone fracture rates were 7.41%, 6.40%, 5.11%, 6.04%, 6.09% and 7.40% in each group. Natural bone fracture rates in each group were 3.01%, 2.21%, 1.31%, 1.65%, 1.43% and 3.66% respectively. The prevalence of bone fracture and water fluoride level appeared a U-shaped relationship. The prevalence of total bone fracture and natural bone fracture in the population with fluoride 1.00-1.06 mg/L in drinking water was the lowest, compared with the groups exposed to fluoride higher than 4.32 mg/L and lower than 0.73 mg/L. The highest prevalence of hip fracture was in the group with higher water fluoride (4.32-7.97 mg/L) exposure. In general, the prevalence of hip fracture was lower and stable up to 1.06 mg/L of fluoride in drinking water, and then it appeared to rise. Based on the data collected in this investigation, it is concluded that the long-term fluoride exposure from drinking water higher than 4.32 mg/L might increase the risk of overall fractures as well as hip fractures. The risk of overall fractures and natural fractures might be lower while the water fluoride level is at 1.00-1.06 mg/L, however, no protective benefits of fluoride for the risk of hip fracture was observed.