Effects of life-long fluoride intake on bone measures of adolescents: a prospective cohort study

The Role of Trace Elements and Minerals in Osteoporosis: A Review of Epidemiological and Laboratory Findings

The objective of the present study was to review recent epidemiological and clinical data on the association between selected minerals and trace elements and osteoporosis, as well as to discuss the molecular mechanisms underlying these associations. We have performed a search in the PubMed-Medline and Google Scholar databases using the MeSH terms "osteoporosis", "osteogenesis", "osteoblast", "osteoclast", and "osteocyte" in association with the names of particular trace elements and minerals through 21 March 2023. The data demonstrate that physiological and nutritional levels of trace elements and minerals promote osteogenic differentiation through the up-regulation of BMP-2 and Wnt/β-catenin signaling, as well as other pathways. miRNA and epigenetic effects were also involved in the regulation of the osteogenic effects of trace minerals. The antiresorptive effect of trace elements and minerals was associated with the inhibition of osteoclastogenesis. At the same time, the effect of trace elements and minerals on bone health appeared to be dose-dependent with low doses promoting an osteogenic effect, whereas high doses exerted opposite effects which promoted bone resorption and impaired bone formation. Concomitant with the results of the laboratory studies, several clinical trials and epidemiological studies demonstrated that supplementation with Zn, Mg, F, and Sr may improve bone quality, thus inducing antiosteoporotic effects.

Effects of fluoride intake on cortical and trabecular bone microstructure at early adulthood using multi-row detector computed tomography (MDCT)

PURPOSE

The aim of this study was to examine the effects of period-specific and cumulative fluoride (F) intake on bone at the levels of cortical and trabecular bone microstructural outcomes at early adulthood using emerging multi-row detector computed tomography (MDCT)-based novel techniques.

METHODS

Ultra-high resolution MDCT distal tibia scans were collected at age 19 visits under the Iowa Bone Development Study (IBDS), and cortical and trabecular bone microstructural outcomes were computed at the distal tibia using previously validated methods. CT scans of a tissue characterization phantom were used to calibrate CT numbers (Hounsfield units) into bone mineral density (mg/cc). Period-specific and cumulative F intakes from birth up to the age of 19 years were assessed for IBDS participants through questionnaire, and their relationships with MDCT-derived bone microstructural outcomes were examined using bivariable and multivariable analyses, adjusting for height, weight, maturity offset (years since age of peak height velocity (PHV)), physical activity (questionnaire for adolescents (PAQ-A)), healthy eating index version 2010 (HEI-2010) scores, and calcium and protein intakes.

RESULTS

MDCT distal tibia scans were acquired for 324 participants from among the total of 329 participants at age 19 visits. No motion artifacts were observed in any MDCT scans, and all images were successfully processed to measure cortical and trabecular bone microstructural outcomes. At early adulthood, males were observed to have stronger trabecular bone microstructural features, as well as thicker cortical bone (p < 0.01), as compared to age-similar females; however, females were found to have less cortical bone porosity as compared to males. Among participants with available F intake estimates (75 to 91% of the 324 with MDCT scans, depending on the period-specific F intake measure), no statistically significant associations were detected between any period-specific or cumulative F intake and bone microstructural outcomes of the tibia at the p < 0.01 level. Only for females, statistically suggestive associations (p < 0.05) were found between recent F intake (from 14 to 19 years) and trabecular mean plate width and trabecular thickness at the tibia. Those associations became somewhat weaker, but still statistically suggestive, for trabecular thickness in fully adjusted analysis with height, weight, PHV, calcium and protein intake, and HEI-2010 and PAQ-A scores as covariates.

CONCLUSION

The findings show that the effects of lifelong or period-specific F intake from combined sources for adolescents typical to the United States Midwest region are not strongly associated with bone microstructural outcomes at age 19 years. These findings are generally consistent with previously reported results of IBDS analyses, which further confirms that effects of lifelong or period-specific F intake on skeletons in early adulthood are absent or weak, even at the levels of cortical and trabecular bone microstructural details.

Rationally designed phenanthrene derivatized triazole as a dual chemosensor for fluoride and copper recognition

A 1,2,3-triazole chemosensor containing phenanthrene and phenol moieties (PhTP) was efficiently synthesized via copper (I)-catalyzed azide-alkyne cycloaddition, "click chemistry". PhTP is a dual analyte sensor for fluoride and copper (II) ions in homogeneous medium. Deprotonation of the phenolic OH proton by the fluoride ion is responsible for a change in fluorescence color from blue (PhTP) to yellowish-orange (PhTP-fluoride adduct), while a charge transfer between the triazole nitrogen of the chemosensor and Cu²⁺ revealed a turn-off fluorescence output. The detection capability of PhTP was analyzed with a series of anions (F^-, Cl^-, Br^-, I^-, H₂PO₄^-, ClO₄^-, OAc^-, BF₄^-) and cations (Fe³⁺, Fe²⁺, Cu²⁺, Ag⁺, Cr³⁺, Al³⁺, Co²⁺, Ni²⁺, Cd²⁺, Zn²⁺). With anions, competitive fluorescence responses under UV lamp were observed for acetate and dihydrogen phosphate anions, but maximum response from fluoride ion was substantiated from steady state absorption and fluorescence experiments. With cations, PhTP displayed a selective and sensitive recognition towards Cu²⁺ ion through spectral modulation in absorption spectroscopy and a turn-off fluorescence response. Nuclear magnetic resonance (NMR) spectroscopic titration studies supported the results obtained through photophysical studies and provided evidence for the ion-binding sites on the probe.

Systemic Effects (Risks) of Water Fluoridation

Abstract Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride would exert its primary preventive effect after being incorporated into the enamel as fluorapatite, making the enamel more resistant to the caries process; however, it is now recognized that the main effect of water fluoridation is local and post eruptive. On the other hand, irrespective of the caries decline reported worldwide, the anticaries benefit of water fluoridation continues to be observed even in developed countries. Regarding the risks, water fluoridation is considered an acceptable community-based method for fluoride delivery, because the risk of developing dental fluorosis lesions due to the ingestion of fluoride during the enamel formation period has been deemed acceptable when contrasted to the anticaries benefits of fluoride. However, the use of fluoride in water to control caries has created a controversy due to data associating water fluoridation as the cause of some systemic diseases. Therefore, the aim of this descriptive review was to discuss the systemic effects (risks) of water fluoridation use.

Fluoridation and county-level secondary bone cancer among cancer patients 18 years or older in New York State

The decision whether to fluoridate drinking water continues to be controversial in some communities. Dental and skeletal fluorosis in response to chronic fluoride overexposure are cited as reasons to avoid community water fluoridation in spite of evidence of the oral and skeletal health benefits fluoridation confers. Community fluoridation of ~ 1 mg/L fluoride has not been found to be associated with primary bone cancer but is associated with improved bone strength. No studies have examined fluoride exposure and secondary bone cancer, a common metastasis with significant morbidity. We hypothesize that fluoridation could diminish the likelihood of secondary bone cancer due to its role in bone fortification. We examined the association between community water fluoridation category and prevalence of secondary bone cancer from 2008 to 2010 among cancer patients of 18 years of age or older in counties in New York State. Relative to counties with less than 25% of the water supply fluoridated, we report no association between secondary bone cancer among cancer patients in counties with 25-75% of the water supply fluoridated (β = 0.02, p = 0.96) and among those in counties with > 75% fluoridated (β = 0.02, p = 0.97). We found no evidence of an association between community water fluoridation category and secondary bone cancer from 2008 to 2010 at the county level in New York State.

Fluoride intake and cortical and trabecular bone characteristics in adolescents at age 17: A prospective cohort study

OBJECTIVE

To investigate the associations between period-specific and cumulative fluoride (F) intakes from birth to age 17 years, and radial and tibial bone measures obtained using peripheral quantitative computed tomography (pQCT).

METHODS

Participants (n = 380) were recruited from hospitals at birth and continued their participation in the ongoing Iowa Fluoride Study/Iowa Bone Development Study until age 17. Fluoride intakes from water, other beverages, selected foods, dietary fluoride supplements and dentifrice were determined every 1.5-6 months using detailed questionnaires. Associations between F intake and bone measures (cortical and trabecular bone mineral content [BMC], density and strength) were determined in bivariate and multivariable analyses adjusted for height, weight, maturity offset, physical activity, and daily calcium and protein intake using robust regression analysis.

RESULTS

Fluoride intake ranged from 0.7 to 0.8 mg F/d for females and from 0.7 to 0.9 mg F/d for males. Spearman correlations between daily F intake and pQCT bone measures were weak. For females, Spearman correlations ranged from r = -.08 to .21, and for males, they ranged from r = -.03 to .30. In sex-specific, height-, weight- and maturity offset- partially adjusted regression analyses, associations between females' fluoride intake and bone characteristics were almost all negative; associations for males were mostly positive. In the fully adjusted models, which also included physical activity, and protein and calcium intakes, no significant associations were detected for females; significant positive associations were detected between F intake from 14 to 17 years and tibial cortical bone content (β = 21.40, P < .01) and torsion strength (β = 175.06, P < .01) for males.

CONCLUSION

In this cohort of 17-year-old adolescents, mostly living in optimally fluoridated areas, lifelong F intake from combined sources was weakly associated with bone pQCT measures.

Associations of fluoride intake with children's cortical bone mineral and strength measures at age 11

OBJECTIVES

There is strong affinity between fluoride and calcium, and mineralized tissues. Investigations of fluoride and bone health during childhood and adolescence show inconsistent results. This analysis assessed associations between period-specific and cumulative fluoride intakes from birth to age 11, and age 11 cortical bone measures obtained using peripheral quantitative computed tomography (pQCT) of the radius and tibia (n = 424).

METHODS

Participants were a cohort recruited from eight Iowa hospitals at birth. Fluoride intakes from water, other beverages, selected foods, dietary supplements, and dentifrice were recorded every 1.5-6 months using detailed questionnaires. Correlations between bone measures (cortical bone mineral content, density, area, and strength) and fluoride intake were determined in bivariate and multivariable analyses adjusting for Tanner stage, weight and height.

RESULTS

The majority of associations were weak. For boys, only the positive associations between daily fluoride intakes for 0-3 years and radius and tibia bone mineral content were statistically significant. For girls, the negative correlations of recent daily fluoride intake per kg of body weight from 8.5 to 11 years with radius bone mineral content, area, and strength and tibia strength were statistically significant. No associations between cumulative daily fluoride intakes from birth to 11 years and bone measures were statistically significant.

CONCLUSIONS

In this cohort of 11-year-old children, mostly living in optimally fluoridated areas, life-long fluoride intakes from combined sources were weakly associated with tibia and radius cortical pQCT measures.

A Rat Experimental Study of the Relationship Between Fluoride Exposure and Sensitive Biomarkers

Chronic excessive fluoride exposure impairs human health and damages not only the skeletal system and the teeth but also the soft tissues such as the brain, liver, kidneys, pancreas and spinal cord. However, there is limited research regarding the exposure levels and sensitive biomarkers. This study was aimed to establish the relationship between fluoride exposure and sensitive biomarkers. Ninety-six rats were randomly divided into six groups, with each group exposed to 0, 2, 4, 8, 16 and 32 mg NaF/(kg.bw), respectively. Correlation analysis of the exposure levels, the tissue distributions and the effects was done, and the possible mathematical relationship between the exposure and sensitive biomarkers is discussed. Our findings revealed that the level of serum fluoride can serve as one of the sensitive indicators to reflect the ex-exposure levels (in the present article, ex-exposure means the fluoride exposure pathway from the outside, which differs from the burden of the organism). Furthermore, an equation determining the external exposure dose of serum fluoride was obtained by fitting the coefficient 0.901. Simultaneously, enzyme levels were closely compared with the burden of the tissue, which showed that the activities of alkaline phosphatase significantly correlated with serum fluoride levels (R ² = -0.259, p < 0.05), as well as with the fluoride levels of the lung (R ² = 0.463, ρ < 0.01), the thymus (R ² = 0.429, ρ < 0.05) and the ovary/testicle (R ² = 0.685, ρ < 0.01). Results suggested that excessive fluoride exposure might affect reproduction by altering the activities of alkaline phosphatase. In addition, some indicators related to immunity and calcium absorption exhibited sensitivity to tissue burden, among which activating transcriptional factor 4 (ATF4), an important indicator involved in bone metabolism, was found sensitive to the ex-exposure level. These findings highlight the gap between health effects in epidemiology research and the total intake amount of fluoride from the environment. This study presents a novel insight into the method of establishing the relationship between fluoride exposure and sensitive biomarkers.

Concentrations of fluoride in water and plasma for US children and adolescents: Data from NHANES 2013-2014

For the first time, for 2013-2014, as part of ongoing National Health and Nutrition Examination Survey, data for fluoride concentrations in water and plasma for U.S. children and adolescents were released in the public domain. This study was undertaken to investigate how fluoride concentrations vary in water and plasma with age, gender, race/ethnicity, housing ownership, use of prescription fluoride drops and/or tablets, exposure to environmental tobacco smoke, and recent use of tobacco products (among adolescents). Fluoride concentrations in water were found to be lower among those aged 3-5 years than those aged 6-11 years (p=0.02), lower for non-Hispanic Asians than Hispanics (p=0.04) among 3-5 years old, lower for non-Hispanic Asians than non-Hispanic blacks (p=0.04) among 6-11 years old, and lower for those who used prescription fluoride drops and/or tablets than those who did not (p≤0.048) among 12-19 years old. Adjusted fluoride concentrations in plasma were found to be lower for females than males (p<0.01) among those aged 6-11 years, lower for Hispanics than non-Hispanic whites (p<0.01) among those aged 12-19 years, and lower for those who used prescription fluoride drops and/or tablets than those who did not (p=0.03) among 12-15 years old. Recent smokers were found to have higher fluoride concentration (p=0.03) in plasma than non-smoker adolescents. Over 60% of the children aged 6-11 years and adolescents aged 12-19 years were at the risk of developing dental caries/decay. About 30% of the children were at the risk of dental fluorosis.

Trace elements have beneficial, as well as detrimental effects on bone homeostasis

The protective role of nutrition factors such as calcium, vitamin D and vitamin K for the integrity of the skeleton is well understood. In addition, integrity of the skeleton is positively influenced by certain trace elements (e.g. zinc, copper, manganese, magnesium, iron, selenium, boron and fluoride) and negatively by others (lead, cadmium, cobalt). Deficiency or excess of these elements influence bone mass and bone quality in adulthood as well as in childhood and adolescence. However, some protective elements may become toxic under certain conditions, depending on dosage (serum concentration), duration of treatment and interactions among individual elements. We review the beneficial and toxic effects of key elements on bone homeostasis.

The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations

Lifestyle choices influence 20-40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. [Table: see text] Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years-a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one's genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.

Evaluation of optimal water fluoridation on the incidence and skeletal distribution of naturally arising osteosarcoma in pet dogs

Experimental toxicological studies in laboratory animals and epidemiological human studies have reported a possible association between water fluoridation and osteosarcoma (OSA). To further explore this possibility, a case-control study of individual dogs evaluated by the UC Davis Veterinary Medical Teaching Hospital was conducted using ecologic data on water fluoridation based on the owner's residence. The case group included 161 dogs with OSA diagnosed between 2008-2012. Two cancer control groups included dogs diagnosed with lymphoma (LSA) or hemangiosarcoma (HSA) during the same period (n = 134 and n = 145, respectively). Dogs with OSA were not significantly more likely to live in an area with optimized fluoride in the water than dogs with LSA or HSA. Additional analyses within OSA patients also revealed no significant differences in age, or skeletal distribution of OSA cases relative to fluoride status. Taken together, these analyses do not support the hypothesis that optimal fluoridation of drinking water contributes to naturally occurring OSA in dogs.