Fluoride and our bones

An interesting history

In late 1990 and early 1991, members of the “Working Group on the Effectiveness of Water Fluoridation” met on numerous occasions in the offices of the National Health and Medical Research Council in Canberra to discuss their draft and soon-to-be-published report titled, The Effectiveness of Water Fluoridation¹.

In March 1991, in the final published version of this report, they admitted they were aware of the possible damage that fluoride can cause to our skeletal system. But they should have been well aware of this potentially adverse effect given that the mild-to-debilitating condition of skeletal fluorosis was identified and documented in detail almost 60 years earlier.

In the early 1930s, two research scientists on either side of the globe, methodically examined factory workers affected by fluoride toxicity in Europe and America. They both independently reported on the crippling damage fluoride was doing to many parts of the body, but especially the skeletal system in the form of skeletal fluorosis. Both independently warned of the consequences of industrial fluoride pollution. Of course factory fluoride exposure was much higher than current ingested fluoride/water levels but the work of these two scientists firmly established that fluoride damages our bones.

We will investigate the science subsequent to these decades-old concerns raised, but first we’ll take a closer look at the NHMRC’s comments. In their 1991 report, The Effectiveness of Water Fluoridation, the Working Group appropriately recommended that measurements of fluoride levels in bone be collected as part of a study. In its recommendation, they wrote:

“If skeletal fluorosis is occurring in Australians, it is likely to be slight, and it will most likely occur in those who drink large amounts of water, or whose renal function is impaired. Studies on bone fluoride collected at autopsy in selected individuals could provide needed reassurance that the current policy is not resulting in hazardous levels of bone accumulation.”

If the Working Group had taken professional and objective measures and instigated a clinical study to examine bone-fluoride levels in Australians consuming water and processed foods containing fluoridation chemicals – as of course they should have done – this would have been the first fluoride harms-related study conducted by NHMRC. If this had been implemented, today we would have a reliable study to evaluate one important aspect of harms directly due to the ingestion of fluoridation chemicals.

Nearly 30 years later, however, not only has this particular recommendation been completely ignored or conveniently avoided, there has still not been one single harms-related study conducted by NHMRC, other than dental fluorosis. But as we point out in our articles Dental fluorosis and Can the NHMRC be trusted?, the methodology used does not engender a great deal of confidence.

Fluoride can cause osteoarthritis

Various studies have shown that skeletal fluorosis can not only produce bone changes that resemble osteoarthritis, it can cause osteoarthritis itself. (Luo 2012; Su 2012; Bao 2003; Savas 2001; Tartatovskaya 1995; Chen 1988; Xu 1987).

In 2003, a Chinese research group lead by Wensheng Bao et al, convincingly demonstrated this link in a well-conducted study. The researchers x-rayed the right hand of adults living in a fluorosis area. They then compared these x-rays with the findings of a nearby non-fluorosis area and the findings of a nationwide study that they had previously conducted. The incidence of osteoarthritis in the fluorosis area was “remarkably higher” than in either the adjacent area or the nation as a whole. According to the researchers, “the osteoarthritis caused by fluorosis differs from ordinary osteoarthritis in severity rather than in nature.”

Fluoride and osteoarthritis – before skeletal fluorosis is evident

For years, US and Australian health authorities have assumed that fluoride does not cause arthritic symptoms before the traditional bone changes of fluorosis are evident on x-ray. Several studies strongly suggests that this long-held assumption is in error.

Savas (2001): This Turkish study found strong evidence of a fluoride-osteoarthritis link in individuals who did not have telltale sign of skeletal fluorosis. The most common radiological finding among the fluorosis patients was knee osteoarthritis — which was found in 66% of the 56 fluorosis patients examined.

Tartatovskaya (1995): This team of Russian researchers found that fluoride-exposed individuals suffer a significantly elevated rate of osteoarthritis in the absence of radiologically detectable fluorosis in the spine.

Czerwinski (1988): Consistent with the Turkish and Russian studies, a team of Polish researchers examined 2,258 fluoride-exposed workers in the aluminum industry and found high rates of arthritic effects in the absence of fluorosis bone changes. Although the researchers could only detect fluorosis by x-ray in 1% of the workers, they found high rates of joint pain in the knee, hip, elbow, shoulder and lumbar spine, with the pains correlating to the duration of fluoride exposure.

Cao (2003): Chinese researchers found that 5 of 19 patients with crippling skeletal fluorosis “presented with mainly articular injury but relatively mild bone pathology.” The researchers termed this condition “fluorosis arthropathy.”

High-quality study shows 50 percent hip fractures

A recently published study from Sweden (Helte et al 2021), found at least 50 per cent higher rates of hip bone fractures in post-menopausal women who consumed drinking water containing up to 1mg/L of fluoride.

This large, high-quality study involved a cohort of more than 4,000 older Swedish women and extended for 13 years – from 2004 to 2017. The largest source of exposure was from naturally occurring fluoride in drinking water, at concentrations at or below 1 mg/L – within the range of Australia’s fluoride concentration. Their total exposures also fell within the same range as women living in fluoridated parts of Australia.

Common misdiagnosis

As fluoride can cause OA in the joints prior to, and in the absence of, detectable osteosclerosis in the spine, skeletal fluorosis is difficult to diagnose. Many doctors are simply not trained to recognise fluoride-induced osteoarthritis (“secondary osteoarthritis”) and therefore many cases will be misdiagnosed as “primary osteoarthritis,” thus depriving patients of the most effective treatment for the condition (reduction in fluoride exposure).

In 1995, Roschger and his team of Austrian researchers highlighted the difficulty of differentiating between osteoarthritis and early stage skeletal fluorosis. In this study, the doctors conducted x-rays of a woman who received high-dose fluoride treatment for six years as an experimental treatment for osteoporosis. After the woman sustained multiple spontaneous fractures, the doctors x-rayed her skeleton and measured her bone density. The“radiographs of the skeleton and bone scintigraphy showed degenerative osteoarthritis,” but none of the traditional signs of skeletal fluorosis. It wasn’t until the doctors performed a bone biopsy that the doctors were able to detect the presence of fluorosis. As the doctors noted, “Without bone biopsy we would have failed the correct diagnosis.” Based on this experience, the doctors concluded that “invasive investigation of the skeleton (bone biopsy, histomorphometry, BSEI plus SAXS) is the only diagnostic tool, when skeletal fluorosis is suspected.”

References

Bao W, et al. (2003). Report of investigations on adult hand osteoarthritis in Fengjiabao Village, Asuo Village, and Qiancheng Village. Chinese Journal of Endemiology 22(6):517-18. Available here.

Cao J, et al. (2003). Brick tea fluoride as a main source of adult fluorosis. Food and Chemical Toxicology 41(4):535-42.

CDC (2011). Osteoarthritis. Available here.

Chen X. (1988): Radiological Analysis of Fluorotic Elbow Arthritis. Journal of Guiyang Medical College 13(2):303-305. Available here.

Czerwinski E, et al. (1988). Bone and joint pathology in fluoride-exposed workers. Archives of Environmental Health 43(5):340-3. Abstract available here.

Ge X, et al. (2006). Investigations on the occurrence of osteoarthritis in middle-aged and elderly persons in fluorosis-afflicted regions of Gaomi City with high fluoride concentration in drinking water. Preventive Medicine Tribune 12(1):57-58. Available here.

Luo R, et al. (2012). Total knee arthroplasty for the treatment of knee osteoarthritis caused by endemic skeletal fluorosis. Chinese Journal of Tissue Engineering Research. Available here.

Petrone P, et al. (2011). Enduring Fluoride Health Hazard for the Vesuvius Area Population: The Case of AD 79 Herculaneum. PLoS ONE 6(6): e21085. Available here.

Tartatovskaya LY, et al. (1995). Clinical and hygiene assessment of the combined effect on the body of vibration and fluorine. Noise and Vibration Bulletin 263-264. Abstract available here.

Roschger P, et al. (1995). Bone mineral structure after six years fluoride treatment investigated by backscattered electron imaging (BSEI) and small angle x-ray scattering (SAXS): a case report. Abstract available here.

Savas S, et al. (2001). Endemic fluorosis in Turkish patients: relationship with knee osteoarthritis. Rheumatology International 21(1):30-5. Abstract available here.

Su WM, et al. (2012). Total hip arthroplasty for the treatment of severe hip osteoarthritis due to fluorosis. Chinese Journal of Tissue Engineering Research 16(9):1543-1546. Available here.

Xu JC, et al. (1987). X-ray findings and pathological basis of bone fluorosis. Chinese Medical Journal 100:8-16. Available here.