Normal age-related changes in fluoride content of vertebral trabecular bone–relation to bone quality

In several clinical osteoporosis studies, fluoride treatment has been shown to have a positive effect on bone mass but without a concomitant decrease in vertebral fracture rate. In contrast, some studies have shown that increases in spinal BMD are also paralleled by decreased vertebral fracture incidence. We have previously demonstrated, in a pig model, that 6-month treatment with fluoride increased bone mass but decreased bone quality. The aim of the present study was to elucidate whether normal age-related fluoride accumulation in human bone per se influences bone quality. From 73 normal individuals, aged 20-91 years (36 females, 37 males) two trabecular bone cylinders were obtained from the central part of L3. Biomechanical competence, ash density, and fluoride content were assessed in one cylinder, and trabecular bone volume was determined in the other. The results showed an age-related decrease in bone mass for both men and women. Bone strength normalized for bone mass (bone quality also identical with bone material strength) also showed an age-related decrease in men and women. Bone fluoride concentration increased significantly in both sexes (range 463-4000 ppm). Multiple regression analyses disclosed that fluoride by itself had no influence on bone quality, in this study with a limited number of cases, when the influence of sex and age were taken into account. It is concluded that normal age-related accumulation of fluoride in vertebral trabecular bone does not seem to affect the quality of bone. Whether this is also the case during fluoride therapy has to be assessed.