Experts recommend drinking fluoridated water to help prevent tooth decay, but questions still remain about fluoride's role in bone health. Many communities in the United States add fluoride to their drinking water to prevent tooth decay. Some scientists have raised concerns about fluoridation's relationship with osteoporosis, a disease that gradually weakens the bones and increases the chance of fractures.
Fluoride has been shown to increase the number of cells that build bone. From the 1950s through the 1980s, sodium fluoride was often suggested as a treatment for osteoporosis. However, in the 1980s, Mayo Clinic researchers discovered, during controlled trials involving postmenopausal women, that fluoride increased bone mineral density but also increased the incidence of fractures, especially in the lower extremities. Research since then has been conflicting, so fluoride therapy for osteoporosis is still controversial.
Just a sampling of the literature on fluoride and bone health shows conflicting results.
In a 1992 issue of the Journal of the American Medical Association, University of Utah researchers reported a study comparing the number of fractures in older adults who resided in areas with and without fluoridated water. The authors concluded, "We found a small but significant increase in the risk of hip fracture in both men and women exposed to artificial fluoridation at 1 ppm (part per million), suggesting that even low levels of fluoride may increase the risk of hip fracture in the elderly."
Another study published in 2000, showed that fluoride did not prevent vertebral fractures, and that increasing fluoride doses was associated with increased risk of non-vertebral fractures and gastrointestinal side effects.
German researchers reported in 1998 that drinking fluoridated water did not affect bone mineral density and may decrease osteoporosis-related hip fractures in people over age 85.
In a more recent study, done in 2006, researchers studied 1,300 women in three small communities that had fluoridated water. Researchers concluded that "long-term exposure to fluoride did not demonstrate an association with bone mineral density or the risk of bone fracture."
According to a study published in 2000 in British Medical Journal, water fluoridation did not appear to increase fracture risk for older women. The 9,704 women were over 65 years old and were followed for an average of seven years during the study. The study found that long-term exposure to fluoridated water cut the risk of hip fractures by 31% and the odds of breaking a vertebrae by 27%.
The Oregon Health Sciences University researchers measured bone mineral density in 9,000 older women and assessed the women's incidence of broken bones and exposure to fluoridated water. Researchers compared women who had been continually exposed to fluoride for the past 20 years with those who had not.
The Oregon research is part of a larger study evaluating associations between broken bones and different factors that might increase or decrease fracture risk. Such studies help researchers formulate hypotheses, but this type of study cannot prove a cause-and-effect relationship. To prove that, scientists would have to take two similar communities, fluoridate one, and follow both for 25-30 years.
Regardless of their positions on fluoridation, osteoporosis experts agree that the best ways to promote bone health are:
International Osteoporosis Foundation
National Osteoporosis Foundation
Women's Health Matters
Fluoride. EBSCO Natural and Alternative Treatments website. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated August 22, 2013. Accessed April 2, 2014.
Danielson C, Lyon J, et al. Hip fractures and fluoridation in Utah's elderly population. JAMA. 1992;268(6):746-8.
Haguenauer D, Welch V, et al. Fluoride for the treatment of postmenopausal osteoporotic fractures: a meta-analysis. Osteoporos Int. 2000;11(9):727-38.
Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 13, 2014. Accessed April 2, 2014.
Phipps KR, Orwoll ES, et al. Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women. BMJ. 2000;321(7265):860-4.
Sowers M, Whitford GM, Clark MK, Jannausch ML. Elevated serum fluoride concentrations in women are not related to fractures and bone mineral density. J Nutr. 2005;135:2247-2252.
Last reviewed April 2014 by Michael Woods, MD
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