Cauley J A, Murphy P A, Riley T J, Buhari A M
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA.
J Bone Miner Res. 1995 Jul;10(7):1076-86. doi: 10.1002/jbmr.5650100712.
To determine if optimal fluoridation of public water supplies influences bone mass and fractures, we studied 2076 non-black women, all aged > or = 65 years recruited into the Study of Osteoporotic Fractures at the Pittsburgh clinic. Information on fluoride exposure was limited to community water supplies. The variable used in the analysis was years of exposure to fluoridated water in community drinking water supplies. Bone mineral density (BMD) was measured at the spine and hip using dual energy X-ray absorptiometry and at the midpoint and ultradistal radius and calcaneus using single photon absorptiometry. Prevalent and incident vertebral fractures were determined by morphometry. Incident nonspine fractures were ascertained every 4 months and confirmed by radiographic report. Exposure to residential fluoridated water had no effect on bone mass. Women exposed to fluoride for > 20 years had similar axial and appendicular bone mass to women not exposed or women exposed for < or = 20 years. There was some suggestion that women exposed to fluoride for > 20 years had a lower relative risk of nonspine fractures (relative risk, RR, = 0.73; 95% confidence interval [CI] 0.48-1.12), osteoporotic fractures, RR = 0.74 (CI 0.46-1.19), and hip fractures, RR = 0.44 (CI 0.10-1.86), compared with women not exposed, but none of these relative risks was statistically significant. There was no association with wrist or spinal fractures. Our results do not support the findings from recent ecological studies which showed an increased risk of hip fracture among individuals exposed to fluoridated public water.
为了确定公共供水的最佳氟化处理是否会影响骨量和骨折情况，我们对2076名非黑人女性进行了研究，这些女性年龄均≥65岁，均在匹兹堡诊所被纳入骨质疏松性骨折研究。关于氟暴露的信息仅限于社区供水。分析中使用的变量是社区饮用水供应中接触氟化水的年限。使用双能X线吸收法测量脊柱和髋部的骨矿物质密度（BMD），使用单光子吸收法测量桡骨中点、远侧端和跟骨的骨矿物质密度。通过形态测量法确定现患和新发椎体骨折。每4个月确定一次新发非脊柱骨折，并通过影像学报告进行确认。接触住宅氟化水对骨量没有影响。接触氟超过20年的女性与未接触或接触氟≤20年的女性相比，其轴向和附属骨骼的骨量相似。有迹象表明，与未接触氟的女性相比，接触氟超过20年的女性发生非脊柱骨折的相对风险较低（相对风险，RR = 0.73；95%置信区间[CI] 0.48 - 1.12），骨质疏松性骨折的相对风险为RR = 0.74（CI 0.46 - 1.19），髋部骨折的相对风险为RR = 0.44（CI 0.10 - 1.86），但这些相对风险均无统计学意义。与腕部或脊柱骨折没有关联。我们的研究结果不支持近期生态学研究的结果，那些研究表明接触氟化公共水的个体髋部骨折风险增加。
