• 26% higher risk of fragility fractures in postmenopausal women

• Risks found even at exposure levels from artificial fluoridation

A new systematic review identified 27 studies of fluoride and bone fractures and found significantly increased risk of fractures in pooled analyses, especially in postmenopausal women. This demographic has the highest risk of hip fractures, which are a major cause of permanent disability and death in older women. Following a hip fracture, 30% are dead within a year and 50% will never be able to walk without assistance.

This review’s finding is consistent with a high-quality study in Sweden which is considered the most rigorous study of fluoride and bone fracture to date but was not included in the pooled analyses. Furthermore, this new paper included dose-response meta-analyses that found increases in fracture rates starting at water fluoride concentrations of about 0.5 milligrams per liter (mg/L), consistent with the Swedish study which found increased fracture risks in an area where the natural water fluoride concentration was 1.0 mg/L or lower.  These exposures are in the same range as people experience who drink artificially fluoridated water at 0.7 mg/L. The paper summarized its key finding:

“Among females over 50 years, who are at notably higher fracture risk than younger subjects there was a … correlation between fluoride exposure and fragility fracture risk starting at fluoride concentrations around 0.5 mg/L.”

A graph from the paper shows the dose-response relationship from 11 studies in this most vulnerable subpopulation. The dose-response relationship is depicted with the black line that rises sharply as the water fluoride concentration goes above 0.5 mg/L [from Figure S6 in Mozzali 2025]:

The vertical axis in this figure is “RR” or Relative Risk. An RR of 1.0 means no increased risk of fracture while RRs above 1.0 indicate greater risk. For example, an RR of 1.2 indicates a 20% greater risk of fractures. In this graph, a Relative Risk of 1.2 occurs at a water fluoride concentration of about 1 mg/L.

When the authors combined all studies including those at younger ages and any sex, some of which were in young children, they reported a possible threshold of about 1.5 mg/L. Combining studies at all ages dilutes the effect at older ages during which almost all fragility fractures occur. Furthermore, while this is a higher concentration than the 0.7 mg/L of artificial water fluoridation, it does not provide any assurance that water fluoridation is safe. Some people drink 2 or 3 times as much water as average so will get the same or higher total dose as the average consumer of water with a 1.5 mg/L fluoride concentration. Also, fluoride sources like tea, dental products, and certain foods must be added to the fluoride from drinking water. Some people with 0.7 mg/L water fluoride will therefore get a total exposure from all sources at least as high as the average exposure among people drinking water with a fluoride concentration of 1.5 mg/L.

Furthermore, some individuals are 10 times more sensitive to any toxic chemical than the average person, and that is why regulatory agencies typically require a 10-fold safety factor be included when setting rules for allowable exposures considered “safe” for everyone.  When a 10-fold safety factor is applied to water fluoride at 1.5 mg/L the resulting safe level for everyone would be 0.15 mg/L, which is much lower than the 0.7 mg/L of artificial fluoridation. The federal court ruling that artificial fluoridation posed an unreasonable risk of IQ loss described the need to incorporate this safety factor (read the full court ruling).

For all these reasons, the claimed threshold of 1.5 mg/L water fluoride found in the pooled analysis for all ages provides no assurance that a concentration of 0.7 mg/L will not increase risk of fractures for some people, especially older people who are most vulnerable. Indeed, in toxicological terms, the margin between 1.5 and 0.7 is so small as to almost guarantee that some people drinking 0.7 mg/L fluoridated water will have an increased risk of bone fractures.

On this same issue there has been much confusion and often misleading claims about the findings of the National Toxicology Program’s (NTP) review of fluoride and IQ. The NTP found the strongest evidence of a link with reduced IQ in studies where the water fluoride concentration was at or above 1.5 mg/L. Fluoridation defenders erroneously claim that 1.5 mg/L is “so much higher” than the 0.7 mg/L of artificial fluoridation that there is no concern for IQ loss from fluoridation.  Nothing could be further from the truth. When the required safety factor of 10x is applied, there is no safe margin for fluoridation. Furthermore, the NTP has emphasized that several high-quality studies have found reduced IQ at fluoride concentrations below 1.5 mg/L, and even below 0.7 mg/L. Some fluoridation defenders falsely deny such studies exist, further distorting the actual evidence.

Chris Neurath, FAN’s Science Director says:

“Just as with fluoride and IQ loss, this new systematic review of fluoride and bone fracture, coupled with the 2021 Swedish study, provides strong evidence that artificial fluoridation likely increases the risk of bone fractures in at least some portion of the population. The most at-risk group is postmenopausal women from hip fractures, which are often debilitating or deadly.”

Neurath described the size of the effects found, “In the new pooled analyses there is a statistically significant 26% greater risk of fragility fractures in postmenopausal women (age 50+), while the Swedish study found a 50% greater risk of hip fractures.” Neurath described the Swedish study as:

“Definitely the strongest study to date, yet it was not included in the pooled analyses because it used fluoride exposure measures that reflect total fluoride exposure instead of just those from drinking water. But the Swedish study’s use of total fluoride is one of its strengths. Almost all other studies have relied on drinking water fluoride concentration. By missing other exposure factors and sources, like the individual’s amount of water consumed and the added fluoride from tea, studies with just water fluoride concentration may underestimate the association between fluoride dose and bone fracture.”

Other strengths of the Swedish study include 1.) use of individual-level data on exposure and potential confounding factors; 2.) large sample size of the most vulnerable subgroup of older women; 3.) control for many potential confounders, more than any other previous study; and 4.) fluoride exposure in the same range as people living with artificially fluoridated water at 0.7 mg/L.

Neurath warns:

“This new review is waving a bright red flag that artificial fluoridation is likely contributing to the enormous toll that hip fractures take on older adults. When considering the other harms now associated with fluoridation, the current science is showing, far from being safe for all, it is likely harming older adults at one end of the age spectrum, the fetus at the other end by damaging the developing brain, and children and pregnant mothers in between. Fluoridation poses risks across the entire lifetime, from ‘womb to tomb’.”