A Brief Account of the Fluoridation And Hip Fracture Problem

The costs and health effects of osteoporotic fractures in the US are enormous. A study by the Department of Preventive Medicine and Environmental Health, U. of Iowa, recently calculated that the life time risk of any fracture of the hip, spine or distal forearm is almost 40% in white women and 13% of men from age 50 years onward. Hip fractures account for 67-79% of fracture-related dependent functioning, 87-100% of fracture-related nursing home placements, and 87-96% of short-term fracture costs. ¹ The total cost of fracture care is now about $9 billion/year. It is estimated that about 350,000 hip fractures occur per year and the incidence is rising.

In an effort to treat osteoporosis and prevent hip fracture, four US studies have examined effect of "therapeutic" doses of fluoride. ^2-5 All of them found that, even though bone density appeared to increase in the treated group, hip fracture rates increased within 3 years of treatment. In addition, all of them report significant periarticular joint pain and gastrointestinal side effects in the treated subjects. Dr. Avioli, Shoenberg Professor of Medicine and director, division of endocrinology and mineral metabolism, Washington University School of Medicine, concluded that "sodium fluoride is accompanied by so many medical complications and side effects that it is hardly worth exploring in depth as a therapeutic mode for post-menopausal osteoporosis." ⁶ Dr. Saul Genuth, chairman of the the FDA advisory committee analyzing these fluoride/fracture findings, was quoted in the Medical World News of 13 November 1989, pg 25, saying the FDA "should quietly forget about fluoride."

More recently, attention has shifted to lower dosages of fluoride, such as found in fluoridated water. There are now at least eight studies that showed an increase of hip fracture incidence in fluoridated compared to unfluoridated communities. They are summarized here:

1. In 1986, M.R. Sowers et al, in a retrospective study, found an increased fracture rate in both pre- and postmenopausal women relative to their water fluoride exposure. ⁷
2. In 1991, M.R. Sowers et al completed a prospective study again showing that water fluoride was correlated with more than double the unfluoridated fracture rates. ⁸
3. In 1991, Jacobsen et al showed a positive correlation of hip fracture to fluoridation; the P value was < .009, i.e., very strong correlation. ⁹ The increase in hip fracture incidence could not be calculated from the data given.
4. Later in 1991, C. Cooper et al showed a statistically significant increase of hip fracture incidence in England relative to fluoride content of drinking water ranging from 0 to 1 mg/L [ppm]. ¹⁰
5. Also in 1991, C. Keller compared hip fracture rates in 216 US counties with low or higher natural fluoride concentrations in drinking water and found significantly higher fracture rates in counties with fluoride > 1.2 ppm. ¹¹
6. At the same meeting, D.S. May and M.G. Wilson reported their finding that, as the percentage of persons exposed to fluoride in water increased, the hip fracture rate generally increased. ¹²
7. In 1992, C. Danielson et al reported that the risk of hip fracture was approximately 30% higher for women and 40% higher for men in fluoridated compared to unfluoridated communities. ¹³ Among women at age 75, the risk was about twice as high in fluoridated communities, compared to unfluoridated communities.
8. In 1995, H. Jaqmin-Gedda et al, scientists from the University of Bordeaux, France, studied hip fracture rates in 75 civil parishes in southwestern France and found, after adjustment for multiple alternative variables, an increased risk [odds ratio] for hip fracture of 1.86, i.e., 86% more likely, in parishes with water fluoride higher than 0.11 ppm. ¹⁴

In addition, a number of studies showing fluoride induces pathologically mineralized bone and a deterioration in the overall mechanical ability (strength) of bone. A recent example is the 1994 report by P. Fratzl et al in the Journal of Bone & Mineral Research describing abnormal bone mineralization after fluoride treatments. ¹⁵ Also in 1994, C.H. Sogaard et al reported a marked decrease in trabecular bone quality after just five years of sodium fluoride therapy. ¹⁶ Pediatric orthopedists are finding that, here in the US, sports injuries to the young are rising sharply, ranging from stress fractures of the lower spine in young gymnasts to tendonitis in swimmers. In 1992, Dr. Carl L. Stanitski, chief of orthopedic surgery, said, "We are seeing more and more stress fractures in children and more and more injuries caused by repetitive use." ¹⁷ Some might argue that overuse and too much training are the cause, but others are concerned that something is causing defective bone and connective tissue of US kids, and that something might well be fluoridation.

Conclusion: All studies of fracture rates relative to long term fluoridation exposure indicate a significant increase in fracture risk from fluoridation. The increased fracture risk due to fluoridation appears to range from 40-100%, depending on the age of the subjects studied. For women in their seventh decade who have been exposed to life-long fluoridation, the risk of hip fracture is approximately doubled. The risk increases with increasing fluoride concentration at all levels over 0.11 ppm. Increased bone and connective tissue injuries of US youngsters, reported to be rising sharply, should alert us to the probability that our high fluoride environment is adversely affecting our youngsters as well as our elderly.

1. Chrischilles E, Shireman T, Wallace R. Costs and health effects of osteoporotic fractures. Bone 1994;15:377-386.
2. Dambacher MA, Ittner J, Ruegsegger P. Long-term fluoride therapy of postmenopausal osteoporosis. Bone 1986;7:199-205.
3. Riggs BL, Hodson SF, O'Fallon WM, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. NEJM 1990;322:802-809.
4. Kleerkoper ME, Peterson E, Phillips E, et al. Continuous sodium fluoride therapy does not reduce vertebral fracture rate in postmenopausal osteoporosis (abstract) J Bone Miner Res 1989; Res 4 [Suppl]:S376.
5. Hedlund LR, Gallagher JC. Increased incidence of hip fracture in osteoporotic women treated with sodium fluoride. J Bone Miner Res 1989;4:223-225.
6. Avioli LV. Fluoride treatment of osteoporosis. Postgrad Med: a special report, 14 Sept 1987:26-27.
7. Sowers MR, Wallace RB, Lemke JH. The relationship of bone mass and fracture history to fluoride and calcium intake: a study of three communities. Am J Clin Nutr 1986;44:889-898.
8. Sowers MR, Clark MK, Jannausch ML, et al. A prospective study of bone mineral content and fracture in communities with differential fluoride exposure. Am J Epidem 1991;133:649-660.
9. Jacobsen SG, Goldberg J, Miles TP, et al. Regional variation in the incidence of hip fracture. JAMA 1991;264:500-502.
10. Cooper C, Wickham CAC, Barker DJR, et al. (Letter) JAMA 1991;266:513-514.
11. Keller C. Fluorides in Drinking Water. Paper presented at the Workship on Drinking Water Fluoride Influence on Hip Fractures and Bone Health. April 10, 1991, Bethesda, MD.
12. May DS, Wilson MG. Hip fractures in relation to water fluoridation: an ecologic analysis. Presented at the Workship of Drinking Water Fluoride Influence on Hip Fractures and Bone Health. April 10, 1991, Bethesda, MD.
13. Danielson C, et al. Hip fractures and fluoridation in Utah's elderly population. JAMA 1992;268:746-748.
14. Jacmin-Gedda H, Commenges D, Dartigues JF. Fluorine concentration in drinking water and fractures in the elderly. (Letter) JAMA 1995;273:775-776.
15. Fratzl P, Roschger F, Eschberger J, et al. Abnormal bone mineralization after fluoride treatment in osteoporosis: a small-angle X-ray-scattering study. J of Bone & Mineral Research 1994, 9:1541-1549.
16. Sogaard Ch, Mosekilde Li, Richards A, Mosikilde Le. Marked Decrease in Trabecular Bone Quality after five years of sodium fluoride therapy - assessed by biomechanical testing of iliac crest bone biopsies in osteoporotic patients. Bone 1994;15:393-399.
17. Reported by Elisabeth Rosenthal in the New York Times of 28 October 1992.

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*John R Lee, MD
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Sebastopol, CA 95472
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