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August 12, 1992, Vol 268, No. 6 >
ARTICLE | August 12, 1992

Hip Fractures and Fluoridation in Utah's Elderly Population FREE

Christa Danielson, MD; Joseph L. Lyon, MD; Marlene Egger, PhD; Gerald K. Goodenough, MD
[+] Author Affiliations

Reprint requests to the Department of Family and Preventive Medicine, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132 (Dr Danielson).


JAMA. 1992;268(6):746-748. doi:10.1001/jama.1992.03490060078027
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References

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 to 1 ppm.

Patients.  —All patients with hip fractures who were 65 years of age and older over a 7-year period in the three communities, excluding (1) those with revisions of hip fractures, (2) those in whom the hip fracture was anything but a first diagnosis, (3) those in whom metastatic disease was present, or (4) those in whom the fracture was a second fracture (n=246).

Outcome Measure.  —Rate of hospital discharge for hip fracture.

Results.  —The relative risk for hip fracture for women in the fluoridated area was 1.27 (95% confidence interval [CI]=1.08 to 1.46) and for men was 1.41 (95% CI=1.00 to 1.81) relative to the nonfluoridated areas.

Conclusions.  —We found a small but significant increase in the risk of hip fracture in both men and women exposed to artificial fluoridation at 1 ppm, suggesting that low levels of fluoride may increase the risk of hip fracture in the elderly.(JAMA. 1992;268:746-748)

REFERENCES

1 +
Lindsay R.  Osteoporosis. Clin Geriatr Med . 1988;; 4:411-429.
2 +
Melton LJ, O'Fallon WM, Riggs BL.  Secular trends in the incidence of hip fractures. Calcif Tissue Int . 1987;;41:57-64.
3 +
Riggs BL, Hodgson SF, O'Fallon WM, et al.  Effect of fluoride on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med . 1990;;322:802-809.
4 +
Evans FG, Wood JL.  Mechanical properties and density of bone in a case of severe endemic fluorosis. Acta Orthop Scand . 1976;;47:489-495.
5 +
Leone NC, Steveson CA, Hilbish TF, Sosman MC.  A roentgenologic study of a human population exposed to high fluoride domestic water: a ten year study. AJR Am J Roentgenol . 1955;;74:874-885.
6 +
Ansell BM, Lawrence JS.  Fluoridation and the rheumatic diseases: a comparison of rheumatism in Watford and Leigh. Ann Rheum Dis . 1965;;25:67-75.
7 +
Iskrant AP.  The etiology of fractured hips in females. Am J Public Health . 1968;;58:485-490.
8 +
Bernstein DS, Sadowsky N, Hegsted DM, Guri CD, Stare FJ.  Prevalence of osteoporosis in high-and low-fluoride areas in North Dakota. JAMA . 1966;;198:499-504.
9 +
Saville PD.  Osteoporosis and fluorides. JAMA . 1966;;199:105-106.
10 +
Simoen O, Laitinen O.  Does fluoridation of drinking-water prevent bone fragility and osteoporosis? Lancet . 1985;;2:432-434.
11 +
Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA.  Regional variation in the incidence of hip fracture: US white women aged 65 and older. JAMA . 1990;;264:500-502.
12 +
Sowers MR, Clark MK, Jannasch ML, Wallace RB.  A prospective study of bone mineral content and fracture in communities with differential fluoride exposure. Am J Epidemiol . 1991;;133:649-660.
13 +
Phipps KR, Burt BA.  Water-borne fluoride and cortical bone mass: a comparison of two communities. J Dent Res . 1990;;69:1256-1260.
14 +
Chiang CL.  Standard error of the age-adjusted death rate.  In: Vital Statistics Special Reports: Selected Studies . Washington, DC: US Dept of Health, Education, and Welfare. 1961;;47.
15 +
Kendall M, Stuart A. The Advanced Theory of Statistics, I: Distribution Theory . New York, NY: MacMillan Publishing Company, Inc; 1977;.
16 +
US Dept of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services; 1989;:76-77. US Dept of Health and Human Services publication CDC 89-8411.
17 +
Lacroix AZ, Lang, J, Scherr P, et al.  Smoking and mortality among older men and women in three communities. N Engl J Med . 1991;;324:1619-1625.
18 +
Piantadosi S, Byar DP, Green SB.  The ecological fallacy. Am J Epidemiol . 1988;;127:893-904.
19 +
Cooper C, Wickham C, Lacey RD, Barker DJP.  Water fluoride concentration and fracture of the proximal femur. J Epidemiol Community Health . 1990;;44:17-19.
20 +
Madans J, Kleinman JC, Cornoni-Huntley J.  The relationship between hip fracture and water fluoridation: an analysis of national data. Am J Public Health . 1983;;73:296-298.
21 +
Alhava EM, Olkkonen H, Kauranen P, Kari T.  The effect of drinking water fluoridation and the fluoride content, strength and mineral density of human bone. Acta Orthop Scand . 1980;;51:413-420.
22 +
Arnala I, Alhava EM, Kivivuori R, Kauranen P.  Hip fracture incidence not affected by fluoridation. Acta Orthop Scand . 1986;;57:433-438.
23 +
Cooper C, Wickham CAC, Barker DJR, Jacobsen SJ.  Water fluoridation and hip fracture. JAMA . 1991;;266:513-514.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Lindsay R.  Osteoporosis. Clin Geriatr Med . 1988;; 4:411-429.
2 +
Melton LJ, O'Fallon WM, Riggs BL.  Secular trends in the incidence of hip fractures. Calcif Tissue Int . 1987;;41:57-64.
3 +
Riggs BL, Hodgson SF, O'Fallon WM, et al.  Effect of fluoride on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med . 1990;;322:802-809.
4 +
Evans FG, Wood JL.  Mechanical properties and density of bone in a case of severe endemic fluorosis. Acta Orthop Scand . 1976;;47:489-495.
5 +
Leone NC, Steveson CA, Hilbish TF, Sosman MC.  A roentgenologic study of a human population exposed to high fluoride domestic water: a ten year study. AJR Am J Roentgenol . 1955;;74:874-885.
6 +
Ansell BM, Lawrence JS.  Fluoridation and the rheumatic diseases: a comparison of rheumatism in Watford and Leigh. Ann Rheum Dis . 1965;;25:67-75.
7 +
Iskrant AP.  The etiology of fractured hips in females. Am J Public Health . 1968;;58:485-490.
8 +
Bernstein DS, Sadowsky N, Hegsted DM, Guri CD, Stare FJ.  Prevalence of osteoporosis in high-and low-fluoride areas in North Dakota. JAMA . 1966;;198:499-504.
9 +
Saville PD.  Osteoporosis and fluorides. JAMA . 1966;;199:105-106.
10 +
Simoen O, Laitinen O.  Does fluoridation of drinking-water prevent bone fragility and osteoporosis? Lancet . 1985;;2:432-434.
11 +
Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA.  Regional variation in the incidence of hip fracture: US white women aged 65 and older. JAMA . 1990;;264:500-502.
12 +
Sowers MR, Clark MK, Jannasch ML, Wallace RB.  A prospective study of bone mineral content and fracture in communities with differential fluoride exposure. Am J Epidemiol . 1991;;133:649-660.
13 +
Phipps KR, Burt BA.  Water-borne fluoride and cortical bone mass: a comparison of two communities. J Dent Res . 1990;;69:1256-1260.
14 +
Chiang CL.  Standard error of the age-adjusted death rate.  In: Vital Statistics Special Reports: Selected Studies . Washington, DC: US Dept of Health, Education, and Welfare. 1961;;47.
15 +
Kendall M, Stuart A. The Advanced Theory of Statistics, I: Distribution Theory . New York, NY: MacMillan Publishing Company, Inc; 1977;.
16 +
US Dept of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services; 1989;:76-77. US Dept of Health and Human Services publication CDC 89-8411.
17 +
Lacroix AZ, Lang, J, Scherr P, et al.  Smoking and mortality among older men and women in three communities. N Engl J Med . 1991;;324:1619-1625.
18 +
Piantadosi S, Byar DP, Green SB.  The ecological fallacy. Am J Epidemiol . 1988;;127:893-904.
19 +
Cooper C, Wickham C, Lacey RD, Barker DJP.  Water fluoride concentration and fracture of the proximal femur. J Epidemiol Community Health . 1990;;44:17-19.
20 +
Madans J, Kleinman JC, Cornoni-Huntley J.  The relationship between hip fracture and water fluoridation: an analysis of national data. Am J Public Health . 1983;;73:296-298.
21 +
Alhava EM, Olkkonen H, Kauranen P, Kari T.  The effect of drinking water fluoridation and the fluoride content, strength and mineral density of human bone. Acta Orthop Scand . 1980;;51:413-420.
22 +
Arnala I, Alhava EM, Kivivuori R, Kauranen P.  Hip fracture incidence not affected by fluoridation. Acta Orthop Scand . 1986;;57:433-438.
23 +
Cooper C, Wickham CAC, Barker DJR, Jacobsen SJ.  Water fluoridation and hip fracture. JAMA . 1991;;266:513-514.

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