Low-Dose Fluoride Shows Some Promise in Osteoporosis
Reuters Health Information 2007. © 2007 Reuters Ltd.
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By David Douglas
NEW YORK (Reuters Health) Aug 06 - Addition of low doses of monofluorophosphate to estrogen therapy may be of use in combating postmenopausal osteoporosis, according to researchers from New Zealand. However, there are hurdles to be overcome.
"Fluoride has been explored in the past for use in osteoporosis," lead investigator Dr. Ian R. Reid told Reuters Health, "but has not been shown to prevent fractures, though it does substantially increase bone density."
"This study used much lower doses than previous studies, and showed that these still powerfully increase bone density, though they still have safety issues with respect to bone quality," he added.
In the June issue of The Journal of Clinical Endocrinology and Metabolism, Dr. Reid and colleagues at the University of Auckland hypothesized that combination of low doses of fluoride along with an antiresorptive agent might be an effective approach.
To investigate, the researchers randomized 80 women who had postmenopausal osteoporosis and had been taking estrogen for at least a year, to additionally have monofluorophosphate or placebo over a period of 4 years. The fluoride content of the supplement was 20 mg per day.
There were progressive increases in lumbar spine bone density over the duration of the study, with a 22% increase in the active treatment group, versus 6% for placebo patients. In the trabecular bone of L3, corresponding increases were 49% and 2.5%.
There were increases elsewhere and there also was a significant rise in bone formation markers in the combination group.
Although there was a reduced incidence of vertebral fractures (hazard ratio, 0.20), non-vertebral fractures were actually increased in the combination group (hazard ratio, 3.3). Moreover, hyperosteoidosis was seen in biopsies from 5 of 7 combination patients, and 2 met criteria for osteomalacia.
Nevertheless, given the favorable aspect of the findings, continued Dr. Reid, "there is further scope to work with smaller doses still, in the hope of finding a dose that is both effective and safe."
"Fluoride could still prove to be an inexpensive and effective treatment for osteoporosis," he concluded.
J Clin Endocrinol Metab 2007;92:2246-2452.
