Treatment of symptomatic osteoporosis with fluoride

Fluoride has been used for > 30 years in the management of osteoporosis. It is one of the few agents that has marked anabolic effects on the skeleton. Indeed, treatment results in continued increments in cancellous bone volume so that cancellous bone volume can be restored to normal in patients with advanced osteoporosis. Despite its long history, both the efficacy and risks of fluoride regimens continue to be the subject of controversy. One of its problems is its age, and much of the early work undertaken utilized methodology and proofs that are today unacceptable. A further problem is that sodium fluoride as a treatment is cheap and not patented (although some formulations are), so that it has been difficult for investigators or industry to make the investments required to provide a modern program of evaluation.