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Fluoride does not cause fractures but its benefits may vary
The benefits to teeth of fluoridating community water supplies are widely acknowledged. A comprehensive summary of the most recent evidence is included in the systematic review by McDonagh et al in this issue of the journal (p 855) but some concerns persist about possible adverse effects on bone. The paper by Phipps et al in this issue of the BMJ (p 860) introduces new evidence on the safety of fluoridating community water supplies. In their multicentre prospective study, Phipps et al found that ambulatory women aged 65 years or older who had been continuously exposed to fluoridated water for the past 20 years had higher bone mineral density at the lumbar spine and hip and a slightly lower risk of hip and vertebral fractures than women who had not been exposed to fluoridated water. The potential confounding effect of other factors known to be associated with fractures, such as oestrogen use, smoking, and body weight, was controlled for at the level of the individual woman.
This was not the case in earlier ecological studies …