An ecologic study [22] compared fracture rates in 216 counties with natural fluoride levels greater than 0.7 ppm with rates in 95 counties with naturally low fluoride (less than 0.4 PPM) in the drinking water (Dose Ecology Study). Hip fracture ratios used as a denominator the hip fracture rates in low fluoride areas. Medicare data obtained from the Health Care Financing Administration, DHHS, was used to obtain hospitalization rates for upper femur and lower spine fractures in men and women over
In a recent article in THE JOURNAL, Jacobsen et al (1) demonstrated a positive ecologic association between hip fracture discharge rates in the United States and fluoride content in water supplies. In a similar study, we recently reported the ecological association of discharge rates for hip fracture and water fluoride levels in 39 county districts in England. (2) Our study was performed in response to the suggestion that fluoridation of water might serve to stem the rising tide of hip fracture
