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New Evidence For the Fracture–Reducing Effectiveness of Monofluorophosphate: Practical Implications Bone and Cartilage Metabolism Unit University of Liege Belgium-Department of Epidemiology & public health, Liege Belgium-Georgetown University Medical Center, Washington, D.C.
Paper republished with permission of its authors
It is widely accepted that fluoride is effective in increasing trabecular bone mass in the spine. However, discrepant results have been obtained from studies evaluating the effect of fluoride salts on cortical bone mass, and more important the quality the newly formed bone and on vertebral and non-vertebral fracture rates. In a double-blind, placebo-controlled, prospective four-year study, we have demonstrated a significant reduction in the number of patients experiencing new vertebral fractures when low dose (20 mg/day) fluoride is given continuously, as monofluorophosphate with a calcium supplement, to women moderately low spinal bone density. Similar results were previously reported when enteric-coated sodium fluoride was compared to the alternative therapies usually prescribed in France, in women with at least one prevalent fracture. More recently, slow-release sodium fluoride intermittently given, significantly reduced individual fractures rates, increased the fracture-free intervals and the survival rate for new fracture in women with prevalent non-traumatic fractures. In contrast, high dose of plain sodium fluoride increased cancellous but decreased cortical bone mineral density at some skeletal sites without significant effect on fracture rates. In a recent study, osteoporotic women treated with a fluoride-calcium-vitamin D regimen experienced no reduction of the vertebral fracture rates compared with the calcium-vitamin D group notwithstanding the evidence of an increase in spinal BMD. These differences are probably related to differences in fluoride doses, formulation and regimens, the duration of the therapy and the nature of the treated population. Since bone forming agents such as fluoride are expected to work mainly by increasing bone mineral content without restoring disrupted bone tissue integrity, they might be particularly useful in mild to moderate osteoporotic subjects in whom the micro-architecture of the skeleton is not excessively damage.
Reginster, J.-Y., Osteoporosis International, Sept. 11-15 1998, vol. 8 ,# 3 p.148