title: Effects of treatment with fluoride on bone mineral density and fracture risk--a meta-analysis.
abstract: Fluoride has fallen into discredit due to the absence of an anti-fracture effect. However, in this meta-analysis, a fracture reducing potential was seen at low fluoride doses [< or =20 mg fluoride equivalents (152 mg monofluorophosphate/44 mg sodium fluoride)]: OR = 0.3, 95% CI: 0.1-0.9 for vertebral and OR = 0.5, 95% CI: 0.3-0.8 for non-vertebral fractures.
  
  
  BACKGROUND
  Fluoride is incorporated into bone mineral and has an anabolic effect. However, the biomechanical competence of the newly formed bone may be reduced.
  
  
  METHODS
  A systematic search of PubMed, Embase, and ISI web of science yielded 2,028 references.
  
  
  RESULTS
  Twenty-five eligible studies were identified. Spine BMD increased 7.9%, 95% CI: 5.4-10.5%, and hip BMD 2.1%, 95% CI: 0.9-3.4%. A meta-regression showed increasing spine BMD with increasing treatment duration (5.04 +/- 2.16%/year of treatment). Overall there was no significant effect on the risk of vertebral (OR = 0.8, 95% CI: 0.5-1.5) or non-vertebral fracture (OR = 0.8, 95% CI: 0.5-1.4). With a daily dose of < or =20 mg fluoride equivalents (152 mg monofluorophosphate/44 mg sodium fluoride), there was a statistically significant reduction in vertebral (OR = 0.3, 95% CI: 0.1-0.9) and non-vertebral (OR = 0.5, 95% CI: 0.3-0.8) fracture risk. With a daily dose >20 mg fluoride equivalents, there was no significant reduction in vertebral (OR = 1.3, 95% CI: 0.8-2.0) and non-vertebral (OR = 1.5, 95% CI: 0.8-2.8) fracture risk.
  
  
  CONCLUSIONS
  Fluoride treatment increases spine and hip BMD, depending on treatment duration. Overall there was no effect on hip or spine fracture risk. However, in subgroup analyses a low fluoride dose (< or =20 mg/day of fluoride equivalents) was associated with a significant reduction in fracture risk.
authors: The Osteoporosis Clinic, Department of Endocrinology and Metabolism C, Aarhus University Hospital Aarhus Amtssygehus, Tage Hansens Gade 2, 8000 Aarhus C, Denmark. p-vest@post4.tele.dk
authors: P
authors: P
authors: Vestergaard
authors: N R
authors: NR
authors: Jorgensen
authors: P
authors: P
authors: Schwarz
authors: L
authors: L
authors: Mosekilde
mesh_terms: D015519:Bone Density / Q000187:drug effects*; D005459:Fluorides / Q000009:adverse effects / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000503:physiopathology / Q000517:prevention & control*; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016103:Spinal Fractures / Q000517:prevention & control; D013131:Spine / Q000502:physiology
chemical_list: D005459:Fluorides
references: Aliment Pharmacol Ther. 2003 Mar 15;17 (6):807-16
references: 12641503
references: Orthop Clin North Am. 1981 Jul;12(3):629-48
references: 7290589
references: Ann Intern Med. 1998 Jul 1 ;129(1):1-8
references: 9652994
references: Bone. 1994 Jul-Aug;15(4):393-9
references: 7917577
references: Osteoporos Int. 1998;8(1):4-12
references: 9692071
references: Rheumatol Int. 2005 May;25(4):296-300
references: 15770482
references: J Clin Endocrinol Metab. 1999 Sep;84(9):3013-20
references: 10487657
references: Acta Med Scand. 1981;209(6):469-71
references: 6455048
references: N Engl J Med. 1990 Mar 22;322(12):802-9
references: 2407957
references: Bone. 1991;12(1):33-7
references: 2054234
references: Skeletal Radiol. 1985;14 (4):276-9
references: 4071102
references: Cochrane Database Syst Rev. 2006 Jul 19;(3):CD005326
references: 16856092
references: Eur J Clin Invest. 1980 Aug;10(4):273-9
references: 6253303
references: N Engl J Med. 1982 Feb 25;306(8):446-50
references: 6276746
references: Cochrane Database Syst Rev. 2000;(4):CD002825
references: 11034769
references: Osteoporos Int. 2007 Jan;18(1):45-57
references: 16951908
references: Osteoporos Int. 1998;8(1):47-52
references: 9692077
references: Eur J Endocrinol. 1994 Apr;130(4):381-6
references: 8162169
references: Osteoporos Int. 2000;11(9):727-38
references: 11148800
references: Metabolism. 1990 Nov;39(11):1118-21
references: 2233270
references: Osteoporos Int. 2002;13(2):158-70
references: 11908491
references: J Clin Endocrinol Metab. 1997 Mar;82(3):753-9
references: 9062477
references: Osteoporos Int. 1995 Mar;5(2):108-14
references: 7599447
references: Miner Electrolyte Metab. 1996;22(4):207-13
references: 8807623
references: J Rheumatol. 1997 Dec;24(12):2308-13
references: 9415633
references: Gastroenterology. 1997 Jul;113(1):219-24
references: 9207281
references: N Engl J Med. 2004 Jan 29;350(5):459-68
references: 14749454
references: Calcif Tissue Int. 1987 Jun;40(6):315-7
references: 3111669
references: Osteoporos Int. 1995;5(6):467-71
references: 8695970
references: Bone. 1985;6(4):201-6
references: 3876838
references: Acta Biomater. 2006 Jan;2(1):113-9
references: 16701866
references: Eur J Gastroenterol Hepatol. 2000 Jan;12(1):19-24
references: 10656205
references: Stat Med. 2003 Sep 15;22(17):2693-710
references: 12939780
references: Osteoporos Int. 1997;7(6):575-82
references: 9604055
references: Lancet. 1988 Aug 13;2(8607):361-5
references: 2899773
references: J Clin Epidemiol. 1997 Jun;50(6):683-91
references: 9250266
references: Ann Intern Med. 1995 Sep 15;123(6):401-8
references: 7639438
references: Osteoporos Int. 1999;9(2):171-8
references: 10367046
references: Aliment Pharmacol Ther. 2002 May;16(5):919-27
references: 11966500
references: Control Clin Trials. 1996 Feb;17(1):1-12
references: 8721797
references: J Bone Miner Res. 1990 Mar;5 Suppl 1:S191-4
references: 2339628
references: Ann Rheum Dis. 1997 Jun;56(6):357-63
references: 9227164
references: Bone. 2000 Jul;27(1):123-8
references: 10865219
references: Bone. 1985;6(5):381-9
references: 3879454
references: Osteoporos Int. 1996;6(2):171-7
references: 8704358
references: Am J Med. 1972 Jul;53(1):43-9
references: 5037288
references: Osteoporos Int. 1991 Jun;1(3):155-61
references: 1790403