ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2014
High fluoride and low calcium levels in drinking water is associated with low bone mass, reduced bone quality and fragility fractures in sheep.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed, 47 citations in OpenAlex.
- Dental fluorosis in the European roe deer (Capreolus capreolus): A review of the pathological changes in the enamel of fluorotic cheek teeth and the abnormal pattern of dental wear in affected dentitions.Anatomical record (Hoboken, N.J. : 2007) · 2026Review
- A comprehensive review and advanced biomolecule-based therapies for osteoporosis.Journal of advanced research · 2025Review
- Variability of the Ionome of Wild Boar (Sus scrofa) and Red Deer (Cervus elaphus) in a Dutch National Park, with Implications for Biomonitoring.Biological trace element research · 2024Article
- Community Water Fluoridation and Rate of Pediatric Fractures.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2023Article
- High Fluoride Ingestion Impairs Bone Fracture Healing by Attenuating M2 Macrophage Differentiation.Frontiers in bioengineering and biotechnology · 2022Article
- Article
- Association Between Dietary Patterns and Fluorosis in Guizhou, China.Frontiers in nutrition · 2019Article
- Ultra-high matrix mineralization of sperm whale auditory ossicles facilitates high sound pressure and high-frequency underwater hearing.Proceedings. Biological sciences · 2018Article
- Vertebral bone microarchitecture and osteocyte characteristics of three toothed whale species with varying diving behaviour.Scientific reports · 2017Article
- Corrosion behavior and cytocompatibility of fluoride-incorporated plasma electrolytic oxidation coating on biodegradable AZ31 alloy.Regenerative biomaterials · 2017Article
- Deterioration of teeth and alveolar bone loss due to chronic environmental high-level fluoride and low calcium exposure.Clinical oral investigations · 2016Article
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Authors and funding
10 authors at 3 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
unlabelledChronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass.
introductionUnderstanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures.
methodsDorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy.
resultsThe fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure.
conclusionsOur data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone mass and (ii) can cause fragility fractures and (iii) that the prevalence of skeletal fluorosis especially due to groundwater exposure should be reviewed in many areas of the world as low bone mass alone does not exclude fluorosis.
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