Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis

B. Lawrence Riggs, Stephen F. Hodgson, W. Michael O'Fallon, Edmund Y S Chao, Heinz W. Wahner, Joan M. Muhs, Sandra L. Cedel, L. Joseph Melton

Research output: Contribution to journalArticle

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Abstract

Although fluoride increases bone mass, the newly formed bone may have reduced strength. To assess the effect of fluoride treatment on the fracture rate in osteoporosis, we conducted a four-year prospective clinical trial in 202 postmenopausal women with osteoporosis and vertebral fractures who were randomly assigned to receive sodium fluoride (75 mg per day) or placebo. All received a calcium supplement (1500 mg per day). Sixtysix women in the fluoride group and 69 women in the placebo group completed the trial. As compared with the placebo group, the treatment group had increases in median bone mineral density of 35 percent (P<0.0001) in the lumbar spine (predominantly cancellous bone), 12 percent (P<0.0001) in the femoral neck, and 10 percent (P<0.0001) in the femoral trochanter (sites of mixed cortical and cancellous bone), but the bone mineral density decreased by 4 percent (P<0.02) in the shaft of the radius (predominantly cortical bone). The number of new vertebral fractures was similar in the treatment and placebo groups (163 and 136, respectively; P not significant), but the number of nonvertebral fractures was higher in the treatment group (72 vs. 24; P<0.01). Fifty-four women in the fluoride group and 24 in the placebo group had side effects sufficiently severe to warrant dose reduction; the major side effects were gastrointestinal symptoms and lower-extremity pain. We conclude that fluoride therapy increases cancellous but decreases cortical bone mineral density and increases skeletal fragility. Thus, under the conditions of this study, the fluoride-calcium regimen was not effective treatment for postmenopausal osteoporosis.

Original languageEnglish (US)
Pages (from-to)802-809
Number of pages8
JournalNew England Journal of Medicine
Volume322
Issue number12
StatePublished - Mar 22 1990

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Fluorides
Osteoporosis
Placebos
Bone Density
Bone and Bones
Therapeutics
Calcium Fluoride
Sodium Fluoride
Postmenopausal Osteoporosis
Femur Neck
Thigh
Femur
Lower Extremity
Spine
Clinical Trials
Calcium
Pain
Cortical Bone

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Riggs, B. L., Hodgson, S. F., O'Fallon, W. M., Chao, E. Y. S., Wahner, H. W., Muhs, J. M., ... Melton, L. J. (1990). Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. New England Journal of Medicine, 322(12), 802-809.

Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. / Riggs, B. Lawrence; Hodgson, Stephen F.; O'Fallon, W. Michael; Chao, Edmund Y S; Wahner, Heinz W.; Muhs, Joan M.; Cedel, Sandra L.; Melton, L. Joseph.

In: New England Journal of Medicine, Vol. 322, No. 12, 22.03.1990, p. 802-809.

Research output: Contribution to journalArticle

Riggs, BL, Hodgson, SF, O'Fallon, WM, Chao, EYS, Wahner, HW, Muhs, JM, Cedel, SL & Melton, LJ 1990, 'Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis', New England Journal of Medicine, vol. 322, no. 12, pp. 802-809.
Riggs BL, Hodgson SF, O'Fallon WM, Chao EYS, Wahner HW, Muhs JM et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. New England Journal of Medicine. 1990 Mar 22;322(12):802-809.
Riggs, B. Lawrence ; Hodgson, Stephen F. ; O'Fallon, W. Michael ; Chao, Edmund Y S ; Wahner, Heinz W. ; Muhs, Joan M. ; Cedel, Sandra L. ; Melton, L. Joseph. / Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. In: New England Journal of Medicine. 1990 ; Vol. 322, No. 12. pp. 802-809.
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