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NEW DATA FROM ENGLAND LINKS FLUORIDATION TO 20% GREATER RATE OF HIP FRACTURES 

Main Findings:

– Public Health England (PHE) buries evidence that fluoridation is associated with higher hip fracture rates.

– Independent analysis of latest data strengthens and confirms that fluoridation poses hip fracture risk in elderly.

– After accounting for confounding variables that PHE failed to consider, the association between fluoridation and hip fractures increased from the PHE finding of 7% higher rate to 20% higher rate.

At the end of July, FAN’s Research Director, Chris Neurath, gave an invited presentation on the association between fluoridation and hip fractures in England at the 2022 Conference of the International Society for Fluoride Research (ISFR), which was held in Harbin, China. Activists can watch Neurath’s 15-minute video presentation titled: Hip fracture incidence and drinking water fluoride in England: Analysis of 2013-2020 data, by clicking on the graphic below:

Neurath collaborated with Penelope Sowter, of Bedford, England, on the study. The study was spurred by the findings of the most recent Water Fluoridation Health Monitoring Report for England, released by Public Health England (PHE) in March 2022 [PHE 2022]. PHE’s name was recently changed to UK Health Security Agency (UKHSA).

PHE Buries Evidence

The PHE 2022 report revealed that hip fracture rates were significantly higher in the fluoridated parts of England, especially for those over age 50 which is when the large majority of hip fractures occur [PHE 2022 Tables 46, 47]. However, PHE tried to bury these findings by focusing on single age groups instead of combining all the data from all ages and then adjusting for age. PHE thereby produced “inconsistencies” by age group and water fluoride group, and dismissed the evidence of a link between fluoride and hip fracture as “unconvincing” in the Executive Summary.

Controlling for additional risk factors reveals 20% greater hip fracture rate in fluoridated areas

We wished to check PHE’s analyses, apply more robust methods, and account for potential confounders that PHE failed to consider. We requested the water fluoride and hip fracture data from PHE in several Freedom of Information requests, but were denied access to the data. This brings into question the integrity of PHE’s report if they are not willing to release its underlying data. PHE also would not release the names of the report’s authors.

Having received no cooperation from PHE, we turned to publicly available information on water fluoride concentration and hip fracture rates by small areas in England, to allow us to do our own independent analysis. We also considered three other factors that have been found to affect hip fracture rates, but which PHE failed to adequately control or even consider in their analyses. These factors were water hardness, poverty in the elderly, and ethnicity. Using multivariable regression analyses, we simultaneously controlled for all these factors, and found that fluoridated water at a concentration of 0.7 mg/L was associated with a 20% higher rate of hip fractures compared to those with low fluoride water. This finding was highly statistically significant.

Hard water protects against hip fractures in England, and PHE’s failure to control for it may explain why they did not find consistent trends between fluoride and hip fractures

An interesting additional finding was that hard water was indeed protective against hip fractures. Much of England has very hard water, but despite this protective factor the adverse effect of fluoridation still outweighs the protective effect of hard water. PHE’s failure to account for the protective effect of water hardness may explain why their analyses were not able to consistently show trends of higher hip fracture rates with higher water fluoride concentration. For geological reasons, the regions in England with water fluoride in the second lowest category (0.1-0.2 mg/L) had a much higher proportion of the population with hard water than in regions with other fluoride concentrations. This likely explains why the 0.1-0.2 mg/L fluoride band hip fracture rate is lower than the 0.0-0.1 mg/L band, thus “bucking the trend” of higher hip fracture rate with higher fluoride concentration. But after we controlled for water hardness, the trend of increasing hip fracture rates with increasing water fluoride became clear. PHE’s analysis didn’t find a consistent trend because they didn’t control for water hardness, and PHE used this false inconsistency as an excuse to say the evidence of harm was “unconvincing”.

Furthermore, the 20% increase in hip fracture rates in fluoridated areas compared to non-fluoridated is likely an underestimate. That’s because the English drink large amounts of tea, which has high levels of fluoride. The average tea consumer in England gets more fluoride from tea than from fluoridated water. Fluoride from tea will therefore reduce the contrast in total fluoride exposure between fluoridated and non-fluoridated populations and thus attenuate, or blur, the observed association between water fluoride and hip fractures.

This is an important issue, because it may explain why a recent very high quality study of fluoride and hip fracture from Sweden found a 50% higher rate of hip fractures associated with a 1 mg/L increase in urine fluoride [Helte 2021, Nicole 2021]. Urine fluoride is a biomarker that reflects total fluoride intake from all sources, so it would include fluoride from both water and tea, and any other sources like swallowed toothpaste. The Swedish study would not suffer any blurring or underestimation of effect and its finding of 50% increased rate of hip fracture is likely closer to the true effect size.

The evidence of increased hip fractures should halt PHE’s plans to mandate and expand fluoridation in England

PHE is currently hoping to expand artificial fluoridation schemes to the entire population of England, from its current coverage of only about 10%. The adverse public health implications of increases in hip fractures from such an expansion of fluoridation outweigh any hoped-for decrease in tooth decay.

Fluoridation is harmful “From Womb to Tomb”

With the accumulating evidence that long term exposure to fluoridated water may significantly increase risk of debilitating and deadly hip fractures in the elderly, combined with the already voluminous evidence that early life fluoride exposure harms the developing brain, it’s time to consider fluoride a hazard “From Womb to Tomb” [FAN Bulletin 2021]. Nobody of any age should be drinking fluoridated water. There are far safer, and just as effective, ways to reduce tooth decay [ChildSmile FAN webpage]. Furthermore, a cavity in a tooth can be fixed, whereas a child’s brain damaged during development or a hip fracture that leaves a grandparent wheelchair-bound or dead, is forever.

Chris Neurath

Science Director

American Environmental Health Studies Project