F.A.N. Newsletter

 From Womb To Tomb

Fluoridation Causes Harm

Fluoride isn't just a neurotoxic risk in pregnant women and infants, 
new Swedish Study finds 50% higher rates of hip fractures in older women

• A study from Sweden ... found 50% higher rates of hip bone fractures in post-menopausal women.
   
• The Swedish women with higher fluoride exposure had slightly higher BMD (Bone Mineral Density), but also higher fracture rates despite the higher BMD.
   
• “About 30% of people with a hip fracture will die in the following year”
   
• “Hip fracture rates among the US population are the highest in the world”

A study from Sweden, published this month, found 50% higher rates of hip bone fractures in post-menopausal women in an area with up to about 1 mg/L fluoride in drinking water [Helte et al 2021].  The high-quality cohort study used detailed information from more than 4,000 older Swedish women enrolled starting in 2004 and followed through 2017.  Their largest source of exposure was from naturally occurring fluoride in drinking water, at concentrations at or below 1 mg/L.  Their total exposures fell within the same range as women living in areas with artificial fluoridation.

Concern for fluoride’s effect on bone quality was raised 25 years ago based on animal studies: “[O]ne cannot help but be alarmed by the negative effects of fluoride on bone strength consistently demonstrated in animal models” [Turner 1995, FAN review animals]. The animal findings prompted human studies.  This new Swedish study builds on previous studies that found increased risk of bone fractures in older people with long-term fluoride exposure [FAN review 1, FAN review 2, FAN review 3].  It is also consistent with extensive experience from Randomized Controlled Trials (RCT) done in the 1990s that attempted to decrease fracture risk for those with osteoporosis by giving patients relatively high doses of fluoride.  Instead of decreasing fracture risk, those studies found increased risk, especially for hip fractures, and the attempts to use fluoride as a medication against osteoporosis have been largely abandoned.  Researchers concluded that although fluoride can increase bone mineral density (BMD), it simultaneously decreases bone quality and bone strength, despite the greater density.  This new Swedish study was at much lower doses than the RCTs, but the women had much longer exposures, which appear to have the same effects as high-dose short-duration exposures.  The Swedish women with higher fluoride exposure had slightly higher BMD, but also higher fracture rates despite the higher BMD.

This study overcomes limitations of most of the previous epidemiological studies, some of which found no increased risk of bone fractures.  Many previous studies had relatively crude group-level exposure measures rather than this study’s individual-level exposures.  This study is also the first to measure urine fluoride concentration, which provides an estimate of total fluoride intake.  Also, to better address long-term exposure, extended residential histories of drinking water fluoride concentration and estimates from detailed dietary questionnaires were used as a second exposure measure.  Fluoride is stored in bones and builds up steadily over many years.  It can reach levels above 1000 parts per million (ppm) in people living in areas with water fluoride of around 1 mg/L, which was the maximum level of most of the women in this Swedish study.

The study not only measured fluoride exposure more carefully than most previous studies, it also controlled for an extensive variety of potential confounding factors, including age, weight, smoking history, physical activity, alcohol intake, calcium intake, Vitamin D supplements, estrogen use, and other factors.  No previous studies have controlled for so many potential confounding factors.

The 50% increased risk of hip fracture was found in the highest tercile (1/3^rd) exposed women, compared to the lowest tercile exposed women.  It was a statistically significant difference.  The study also found 10 to 20% higher rates of fractures for all types of bone fractures, and for those types commonly associated with osteoporosis.

This new study has serious implications for the practice of fluoridation.  Its findings suggest that long term consumption of fluoridated water may be responsible for 50% or more of hip fractures experienced by older people.  There are about 2 million osteoporotic fractures in the US per year, of which about 300,000 are hip fractures [Lewiecki 2018].  Hip fractures in the elderly are a leading cause of disability and death.  “About 30% of people with a hip fracture will die in the following year” [Brauer 2019].  “Of those who survive, many do not re-gain their pre-fracture level of function. About 50% of patients with hip fractures will never be able to ambulate without assistance and 25% will require long-term care” [Lewiecki 2018]. Water fluoridation may literally be killing older people, taking years off their lives or leaving them confined to wheelchairs.  “Treating hip fractures is also very expensive. A typical patient with a hip fracture spends US $40,000 in the first year following hip fracture for direct medical costs and almost $5,000 in subsequent years” [Brauer 2019].

Widespread fluoridation in the US might help explain why “Hip fracture rates among the US population are the highest in the world” [Dhanwal 2011].

Just as with the fluoride neurotoxicity studies that are finally being taken seriously, and funded by government agencies, this new study could help spur more high-quality studies on bone effects of fluoride.  But there is already more than enough evidence of risk to the brain, and now to bone health, that there is no justification to continue intentionally adding fluoride to drinking water for the sole purpose of trying to reduce tooth decay.

Chris Neurath
Science Director
Fluoride Action Network