Community water fluoridation, bone mineral density, and fractures: Prospective study of effects in older women

Kathy R. Phipps, Eric Orwoll, Jill D. Mason, Jane A. Cauley

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To determine whether fluoridation influences bone mineral density and fractures in older women. Design: Multicentre prospective study on risk factors for osteoporosis and fractures. Setting: Four community based centres in the United States. Participants: 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Main outcome measures: Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Results: Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n = 3218) and women with no exposure during the past 20 years (n = 2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm2, P <0.001), 2.5% higher at the lumbar spine (0.022 g/cm2, P <0.001), and 1.9% lower at the distal radius (0.007 g/cm2, P = 0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P = 0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P = 0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P = 0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P = 0.378). Conclusions: Long term exposure to fluoridated drinking water does not increase the risk of fracture.

Original languageEnglish (US)
Pages (from-to)860-864
Number of pages5
JournalBritish Medical Journal
Volume321
Issue number7265
StatePublished - Oct 7 2000

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Fluoridation
Bone Fractures
Bone Density
Prospective Studies
Spine
Humerus
Wrist
Fluorides
Hip
Calcaneus
Femur Neck
Hip Fractures
Drinking Water
Femur
Osteoporosis
Multicenter Studies
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Water

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Community water fluoridation, bone mineral density, and fractures : Prospective study of effects in older women. / Phipps, Kathy R.; Orwoll, Eric; Mason, Jill D.; Cauley, Jane A.

In: British Medical Journal, Vol. 321, No. 7265, 07.10.2000, p. 860-864.

Research output: Contribution to journalArticle

Phipps, Kathy R. ; Orwoll, Eric ; Mason, Jill D. ; Cauley, Jane A. / Community water fluoridation, bone mineral density, and fractures : Prospective study of effects in older women. In: British Medical Journal. 2000 ; Vol. 321, No. 7265. pp. 860-864.
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N2 - Objective: To determine whether fluoridation influences bone mineral density and fractures in older women. Design: Multicentre prospective study on risk factors for osteoporosis and fractures. Setting: Four community based centres in the United States. Participants: 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Main outcome measures: Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Results: Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n = 3218) and women with no exposure during the past 20 years (n = 2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm2, P <0.001), 2.5% higher at the lumbar spine (0.022 g/cm2, P <0.001), and 1.9% lower at the distal radius (0.007 g/cm2, P = 0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P = 0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P = 0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P = 0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P = 0.378). Conclusions: Long term exposure to fluoridated drinking water does not increase the risk of fracture.

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