Abstract
The purpose of this prospective study was to investigate the quantity and quality of bone by quantitative ultrasound (QUS) measurements and to assess bone resorption by urinary excretion measurement of C-terminal telopeptide of type I collagen (CTX) in an adult Turkish population living in an endemic fluorosis area and consuming drinking water with a high fluoride (F) concentration (mean 3.57 ppm F). Excretion of urinary CTX, heel broadband ultrasound attenuation (HBUA; dB/MHz), and speed of sound (SOS; m/s) were examined in 122 Turkish adults (37 pre-menopausal, 40 post-menopausal women, and 45 men) living in the endemic fluorosis area. For comparison, the same measurements were made on 117 controls (48 pre-menopausal women, 34 post-menopausal women, and 35 men) living in a nonendemic low F water area (mean 0.4 ppm F). In the F endemic area urinary excretion of CTX was higher in all subjects, whereas calcaneal BUA was lower in post-menopausal women. In the F endemic area SOS was significantly greater among pre-menopausal women but was not significantly different in the other two groups. Although non-trauma bone fracture rates were not significantly different among any of the groups, some of the bone marker differences indicate that exposure to prolonged high concentration of F may increase the risk of bone fracture, especially in post-menopausal women.
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Effects of dialysate calcium and fluoride on bone disease during regular hemodialysis
A previous study indicated that, in patients maintained by hemodialysis, clinically and roentgenographically apparent bone disease appeared almost exclusively when the dialystate calcium concentration was less than 5.7 mg per 100 ml. In the present study, bone biopsy specimens from the iliac crest were studied at the beginning and end
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The effects of fluoridation on degenerative joint disease (DJD) and hip fractures
Fluoride strengthens bone, yet makes it more susceptible to fracture. If mechanical factors are important in DJD, an increased risk for DJD in communities where fluoride is consumed is also expected. Hip fractures and knee DJD joint replacements among those >65 years for 1991-1996 were compared between one community with
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A prospective study of bone mineral content and fracture in communities with differential fluoride exposure
In 1983/1984, a study of bone mass and fractures was begun in 827 women aged 20-80 years in three rural Iowa communities selected for the fluoride and calcium content of their community water supplies. The control community's water had a calcium content of 67 mg/liter and a fluoride content of
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Exposure to natural fluoride in well water and hip fracture: a cohort analysis in Finland
In the retrospective cohort study based on record linkage, the authors studied a cohort of persons born in 1900-1930 (n = 144,627), who had lived in the same rural location at least from 1967 to 1980. Estimates for fluoride concentrations (median, 0.1 mg/liter; maximum, 2.4 mg/liter) in well water in
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Hip fractures and fluoridation in Utah's elderly population
OBJECTIVE: To test the effect of water fluoridated to 1 ppm on the incidence of hip fractures in the elderly. DESIGN: Ecological cohort. SETTING: The incidence of femoral neck fractures in patients 65 years of age or older was compared in three communities in Utah, one with and two without water fluoridated
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Factors which increase the risk for skeletal fluorosis
The risk for developing skeletal fluorosis, and the course the disease will take, is not solely dependent on the dose of fluoride ingested. Indeed, people exposed to similar doses of fluoride may experience markedly different effects. While the wide range in individual response to fluoride is not yet fully understood, the following are some of the factors that are believed to play a role.
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Fluoride & Spontaneous Hip Fractures in Osteoporosis Patients
Due to its ability to increase vertebral bone mass, fluoride has been used as an experimental treatment for osteoporosis (doses > 20 mg/day). Fluoride treatment, however, proved far more harmful than beneficial. Not only was fluoride therapy shown to increase fracture rates among the treated patients, it was also found to
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Fluoride in Water & Bone Fracture
Current epidemiological evidence indicates that the margin of safety between the level of fluoride in water that does, and does not, increase the risk of fracture is insufficiently large to protect all members of society from fluoride-induced damage to bone.
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"Pre-Skeletal" Fluorosis
As demonstrated by the studies below, skeletal fluorosis may produce adverse symptoms, including arthritic pains, clinical osteoarthritis, gastrointestinal disturbances, and bone fragility, before the classic bone change of fluorosis (i.e., osteosclerosis in the spine and pelvis) is detectable by x-ray. Relying on x-rays, therefore, to diagnosis skeletal fluorosis will invariably fail to protect those individuals who are suffering from the pre-skeletal phase of the disease. Moreover, some individuals with clinical skeletal fluorosis will not develop an increase in bone density, let alone osteosclerosis, of the spine. Thus, relying on unusual increases in spinal bone density will under-detect the rate of skeletal fluoride poisoning in a population.
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Mechanisms by which fluoride may reduce bone strength
Based on a large body of animal and human research, it is now known that fluoride ingestion can reduce bone strength and increase the rate of fracture. There are several plausible mechanisms by which fluoride can reduce bone strength. As discussed below, these mechanisms include: Reduction in Cortical Bone Density De-bonding of
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