Fluoride therapy for osteoporosis: A review of dose response, duration of treatment, and skeletal sites of action

Abstract

Osteoporosis is a disease characterized by a reduction in bone density which predisposes to fracture after even minimal trauma. Fluoride, because it has consistently been shown to stimulate bone formation and increase trabecular bone density, has been widely studied for the treatment of osteoporosis. The article focuses on the dose response, duration of treatment, and skeletal sites of action of fluoride; we also include comments on the effect of fluoride on vertebral and appendicular fracture rates. The skeletal response to fluoride doses, ranging from 15 to 43 mg elemental fluoride per day, included a linear increase in spinal bone density at an average rate of 1.25 +/- 0.91 mg/cm3 per month. The rate of increase in spinal bone density was related to the dose of fluoride (r = 0.34, P less than 0.03). Spinal bone density had increased above the fracture threshold in 44% of patients treated with fluoride for 32 +/- 10 months. The time required to achieve this goal was, however, influenced by the pretreatment spinal bone density and interpatient variation in response to fluoride treatment. Patients whose spinal bone density remained below the fracture threshold had lower pretreatment bone densities and/or slower rates of increase in spinal bone density (P less than 0.001). The osteogenic effect of fluoride was not limited to the spine. After 2 years of fluoride therapy, we found bone density in the femoral condyle (measured by QCT) to have increased by 13 +/- 2.6 mg/cm3 (n = 38, P less than 0.001); bone density in the hip (measured by DPA) was increased by 0.0261 +/- 0.015 g/cm2 (n = 55, P less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Österreichischer Leitfaden zur medikamentösen Therapie der postmenopausalen Osteoporose – Update 2009

“…Das optimale therapeutische Fenster dürfte zwischen 20 und 30 mg verfügbaren Fluorids t€ aglich liegen [334], möglicherweise aber sogar unter 20 mg. Eine Tagesdosis unter 13-18 mg verfügbaren Fluorids zeigt jedenfalls keine Wirkung auf den Knochen, eine Tagesdosis über 34 mg führt hingegen zur Bildung eines abnormen Knochens mit verminderter Stabilit€ at [335].…”

Treatment of osteoporosis: Current status and recent advances

“…144 Although there is debate about the optimal dose of fluoride, most studies suggest a dose of 20-30 mg fluoride ion per day. 151 By comparison, fluoride for prevention of dental caries is 2-4 mg per day. About 50% of fluoride-treated patients have substantial increases in bone mass, 25% have incomplete responses, and 25% have no response.…”

Leitfaden zur medikamentosen Therapie der postmenopausalen Osteoporose

“…Ob diese scheinbar widerspru È chlichen Effekte letztlich eine Frage der Dosierung, der verwendeten Fluoridverbindung, der Galenik oder der Kombination einzelner dieser Faktoren sind, konnte bislang nicht sicher gekla Èrt werden (62). Das optimale therapeutische Fenster du È rfte zwischen 20 und 30 mg verfu È gbaren Fluorids ta Èglich liegen (38). Eine Tagesdosis unter 13±18 mg verfu È gbaren Fluorids zeigt jedenfalls keinen Effekt auf den Knochen, eine Tagesdosis u È ber 34 mg hingegen fu È hrt zur Bildung eines abnormen Knochens mit verminderter Stabilita Èt (39).…”