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Fluoride in Drinking Water, Diet, and Urine in Relation to Bone Mineral Density and Fracture Incidence in Postmenopausal Women
Environmental Health Perspectives ( IF 10.4 ) Pub Date : 2021-4-6 , DOI: 10.1289/ehp7404
Emilie Helte 1 , Carolina Donat Vargas 1, 2 , Maria Kippler 3 , Alicja Wolk 1, 4 , Karl Michaëlsson 4 , Agneta Åkesson 1
Affiliation  

Abstract

Background:

Although randomized controlled trials (RCTs) have demonstrated that high fluoride increases bone mineral density (BMD) and skeletal fragility, observational studies of low-dose chronic exposure through drinking water (<1.5mg/L, the maximum recommended by the World Health Organization) have been inconclusive.

Objective:

We assessed associations of fluoride in urine, and intake via diet and drinking water, with BMD and fracture incidence in postmenopausal women exposed to drinking water fluoride 1mg/L.

Methods:

Data were from participants in the Swedish Mammography Cohort–Clinical, a population-based prospective cohort study. At baseline (2004–2009), fluoride exposure was assessed based on urine concentrations (n=4,306) and estimated dietary intake (including drinking water) (n=4,072), and BMD was measured using dual energy X-ray absorptiometry. Incident fractures were ascertained via register-linkage through 2017. Residential history was collected to identify women with long-term consistent drinking water exposures prior to baseline.

Results:

At baseline, mean urine fluoride was 1.2mg/g creatinine (±1.9) and mean dietary intake was 2.2mg/d (±0.9), respectively. During follow-up, 850, 529, and 187 cases of any fractures, osteoporotic fractures, and hip fractures, respectively, were ascertained. Baseline BMD was slightly higher among women in the highest vs. lowest tertiles of exposure. Fluoride exposures were positively associated with incident hip fractures, with multivariable-adjusted hazard ratios of 1.50 (95% CI: 1.04, 2.17) and 1.59 (95% CI: 1.10, 2.30), for the highest vs. lowest tertiles of urine fluoride and dietary fluoride, respectively. Associations with other fractures were less pronounced for urine fluoride, and null for dietary fluoride. Restricting the analyses to women with consistent long-term drinking water exposures prior to baseline strengthened associations between fractures and urinary fluoride.

Discussion:

In this cohort of postmenopausal women, the risk of fractures was increased in association with two separate indicators of fluoride exposure. Our findings are consistent with RCTs and suggest that high consumption of drinking water with a fluoride concentration of 1mg/L may increase both BMD and skeletal fragility in older women. https://doi.org/10.1289/EHP7404



中文翻译:

饮水、饮食和尿液中的氟化物与绝经后妇女骨矿物质密度和骨折发生率的关系

摘要

背景:

尽管随机对照试验 (RCT) 已证明高氟化物会增加骨矿物质密度 (BMD) 和骨骼脆性,但通过饮用水长期暴露于低剂量的观察性研究。<1.5毫克/大号,世界卫生组织推荐的最大值)尚无定论。

客观的:

我们评估了尿液中氟化物以及通过饮食和饮用水摄入的氟化物与暴露于饮用水氟化物的绝经后妇女的 BMD 和骨折发生率之间的关系1毫克/大号.

方法:

数据来自瑞典乳房 X 线摄影队列临床研究的参与者,这是一项基于人群的前瞻性队列研究。在基线(2004-2009),氟化物暴露是根据尿液浓度评估的(n=4,306) 和估计的膳食摄入量(包括饮用水)(n=4,072),并使用双能 X 射线吸收法测量 BMD。通过 2017 年的登记联系确定事故骨折。收集居住史以识别在基线之前长期持续接触饮用水的女性。

结果:

基线时,平均尿氟含量为1.2毫克/G肌酐(±1.9) 平均膳食摄入量为2.2毫克/d(±0.9), 分别。在随访期间,分别确定了 850、529 和 187 例任何骨折、骨质疏松性骨折和髋部骨折。处于最高与最低暴露三分位数的女性的基线 BMD 略高。氟化物暴露与髋部骨折事件呈正相关,多变量调整后的风险比分别为 1.50(95% CI:1.04, 2.17)和 1.59(95% CI:1.10, 2.30),尿氟含量最高与最低三分位数和膳食氟化物,分别。尿氟化物与其他骨折的关联不太明显,而饮食氟化物则为零。将分析仅限于在基线之前长期接触饮用水的女性,这加强了骨折和尿氟之间的关联。

讨论:

在这组绝经后妇女中,骨折风险与氟化物暴露的两个独立指标相关。我们的研究结果与 RCT 一致,表明大量饮用氟化物浓度为1毫克/大号可能会增加老年女性的 BMD 和骨骼脆弱性。https://doi.org/10.1289/EHP7404

更新日期:2021-04-08
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