Water fluoridation and osteoporotic fracture

Area of Science:

• Bone health and public health policy
• Skeletal effects of fluoride exposure

Background:

• Osteoporotic fractures are a significant public health concern, with heterogeneous causes.
• Water fluoridation is common for dental health, but its skeletal risks and benefits are debated.
• Fluoride impacts bone cells, structure, and strength by forming fluoroapatite and stimulating osteoblasts.

Purpose of the Study:

• To evaluate the skeletal risks and benefits of water fluoridation.
• To assess the relationship between fluoride intake and osteoporotic fracture incidence.
• To review existing evidence on water fluoridation and bone health.

Main Methods:

• Review of animal studies on fluoride intake and bone strength.
• Analysis of clinical trials using sodium fluoride for osteoporosis treatment.
• Examination of epidemiological studies, including ecological comparisons and individual-level analyses, on water fluoride concentration and hip fracture incidence.

Main Results:

• High-dose sodium fluoride increases bone mineral density but not vertebral fracture incidence.
• Low-dose sodium fluoride may offer benefits for bone density and fracture risk.
• Epidemiological evidence on water fluoridation and hip fracture is inconclusive, with some studies suggesting a weak adverse effect at the individual level.

Conclusions:

• The current epidemiological evidence linking water fluoridation to hip fracture is inconclusive and based on ecological data.
• Further individual-level studies are needed to clarify the relationship between fluoride intake, bone mineral density, and hip fracture risk.
• The existing evidence is insufficient to halt water fluoridation programs, but potential risks warrant further investigation.