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Bone 1994 15(4): 393-399
Marked decrease in trabecular bone
quality after five years of sodium fluoride therapy--assessed by biomechanical
testing of iliac crest bone biopsies in osteoporotic patients.
Sogaard CH, Mosekilde L, Richards A, Mosekilde L.
Department of Connective Tissue Biology, University of Aarhus, Denmark.
Sodium fluoride has for more than 2 decades been a commonly used therapeutic
agent for established osteoporosis because of a repeatedly documented anabolic
effect on trabecular bone mass. Recently, however, three controlled trials
have failed to demonstrate any therapeutic advantage of NaF over placebo
with respect to vertebral fracture rate. Also, there have been several reports
of an increased incidence of nonvertebral fractures during fluoride administration.
Thus, the efficacy of fluoride therapy remains a controversial issue. The
aim of this longitudinal study was to investigate the effect of sodium fluoride
(40-60 mg per day), calcium (45 mmol), and vitamin D2 (18,000 IU) on trabecular
bone strength, assessed before and after 1 or 5 years of treatment for osteoporosis.
Iliac crest biopsies were taken before and after 1 year of treatment in
12 patients, and before and after 5 years of treatment in 14 patients. Measurements
were made of biomechanical competence, ash content, and bone fluoride content,
and bone strength parameters were normalized for ash content, thereby obtaining
a measure of trabecular bone quality. Bone fluoride content was significantly
increased after both 1 and 5 years of treatment, indicating that the administered
fluoride had been ingested. After 1 year of treatment, no difference was
observed in iliac crest trabecular bone ash content. A general trend for
decreased bone strength and bone quality was observed, but this was insignificant.
After 5 years of fluoride treatment, an insignificant decrease in iliac
crest trabecular bone ash content was observed. A significant reduction
of 45% was found in trabecular bone strength (p < 0.05), and an even
more pronounced reduction of 58% was found in trabecular bone quality (p
< 0.01). The results of this study indicate that long-term administration
of sodium fluoride may be detrimental to bone quality, at least as measured
in nonloaded iliac crest bone.
Publication Types:
* Clinical Trial
PMID: 7917577 [PubMed - indexed for MEDLINE]
Note: On PubMed, the above abstract is truncated at 250 words, and thus the following section of the abstract is left out: "A significant reduction of 45% was found in trabecular bone strength (p < 0.05), and an even more pronounced reduction of 58% was found in trabecular bone quality (p < 0.01). The results of this study indicate that long-term administration of sodium fluoride may be detrimental to bone quality, at least as measured in nonloaded iliac crest bone." See PubMed abstract.
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