Fluoridation: the hip fracture deception

Warning – this book is deceptive

One of the myths promoted by the anti-fluoride people is that fluoridation is bad for our bones. As with similar myths the evidence used to support the claims usually comes from studies of situations where people have high F intake, often from natural sources.

However, there are studies which anti-fluoridationists can quote which do relate to fluoridated water concentrations.  For example, this is one of the many claims made by Christopher Bryson in his book The Fluoride Deception. This book tends to be used as scripture by anti-fluoridationists today so I thought I would look a bit more deeply into his claim.

Such deeper looks can often show problems of confirmation bias or uncritical evaluation of the literature – it did in this case.

1992

Bryson based his claim solely on work by Joseph Lyon, in particular the paper Hip Fractures and Fluoridation in Utah’s Elderly Population by Christa Danielson; Joseph L. Lyon; Marlene Egger; and Gerald K. Goodenough (1992). However, he does claim  “subsequent studies have found similar associations between fluoride in water and bone fractures.”

Danielson et al. concluded:

“We found a small but significant increase in the risk of hip fracture in both men and women exposed to artificial fluoridation at 1 ppm, suggesting that low levels of fluoride may increase the risk of hip fracture in the elderly”

2000

Well, it doesn’t take much searching to find papers with contrary conclusions. For example Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women by
Kathy R Phipps, Eric S Orwoll, Jill D Mason, Jane A Cauley (2000).

They concluded:

“Long term exposure to fluoridated drinking water does not increase the risk of fracture.”

So different conclusions, but why? Well Phipps et al. allude to the causes of contradictory conclusions in their introduction.

“While the benefit of fluoridation in the prevention of dental caries has been overwhelmingly substanti­ated, the effect of fluoridation on bone mineral density and rates of fracture is inconsistent. Ecological studies that compare rates of fracture specific for age and sex between fluoridated and non­fluoridated communities have variously found that exposure to fluoridated water increases the risk of hip fracture, (here they refer to Danielson et al 1992) increases the risk of proximal humerus and distal forearm fracture, has no effect on fracture risk, and decreases the risk of hip fracture. Ecological studies, however, have a major design flaw—they are based on community level data and cannot control for confounding variables at the individual level.” (My emphasis).

In contrast:

“We determined, on an individual level, whether older women with long term exposure to fluoridated water had different bone mass and rates of fracture compared with women with no exposure.” (My emphasis).

And they concluded:

“This is the first prospective study with adequate power to examine the risk of specific fractures associated with fluoride on an individual rather than a community basis. Our results show that long term exposure to fluoridation may reduce the risk of fractures of the hip and vertebrae in older white women. Because the bur­den of osteoporosis is largely due to fractures of the hip, this finding may have enormous importance for public health. If fluoridation does reduce the risk of hip fracture it may be one of the most cost effective meth­ods for reducing the incidence of fractures related to osteoporosis. In addition, our results support the safety of fluoridation as a public health measure for the con­trol of dental caries.”

So, if we compare the results from the two studies we see that while Danielson et al (1992) reported an increase in the risk of hip fracture for women drinking fluoridated water, Phipps et al (2000) actually reported a decrease in the risk. The difference being that Phipps et al (2000) removed confounding factors such as  medical history, drugs and supplements, reproductive history, menopause, alcohol consumption, exercise, smoking, caffeine intake, height and weight.

hip-fract

Relative risk of hip fracture for women with fluoride exposure compared to women with no fluoride exposure

2013

While preparing this I noted a new paper on this subject just published – Näsman et al (2013) “Estimated Drinking Water Fluoride Exposure and Risk of Hip Fracture:A Cohort Study

The abstract reports:

“Estimated individual drinking water fluoride exposure was stratified into 4 categories: very low, < 0.3 mg/L; low, 0.3 to 0.69 mg/L; medium, 0.7 to 1.49 mg/L; and high, ≥ 1.5 mg/L. Overall, we found no association between chronic fluoride exposure and the occurrence of hip fracture. . . . fluoride exposure from drinking water does not seem to have any important effects on the risk of hip fracture, in the investigated exposure range.”

So extra support for the conclusion that fluoridation does not lead to increased risk of hip fracture.

Motivated cherry picking

I think this shows the danger of cherry picking studies to support a preconceived position. And of relying on individual sources, or ideologically motivated sources like  The Fluoride Deception, for information.

There is a large amount of research on fluoride which to the uninitiated must seem contradictory. Proper review of this literature requires skills in critical thinking, and background in the field. The sort of thing that activist groups, and local body councils, don’t have.

Of course, I have no special background in this area either – and I don’t pretend that my summary here is at all definitive. However, it does show how misinformation can easily be promoted, with an apparent respectability conferred by  scientific references, when motivated people cherry pick.

See also:

Similar articles on fluoridation
Making sense of fluoride Facebook page
Fluoridate our water Facebook page
New Zealanders for fluoridation Facebook page

21 responses to “Fluoridation: the hip fracture deception

  1. Hi Ken,
    Nasman et al. (2013) is a contribution to the fluoridation literature but who is motivated by cherry picking now? Even they say that the knowledge of possible adverse effects on bone and fracture risk due to fluoride exposure is ambiguous.

    You say that the proper review of this literature requires skills in critical thinking, and background in the field – the sort of thing that activist groups, and local body councils, don’t have but even the most ardent current critics of fluoridation say that on hip fracture the evidence is mixed.

    See The Case Against Fluoride – How hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there. Paul Connett, PhD, James Beck, MD, PhD and H. S. Micklem, DPhil, Chelsea Green Publishing, White River Junction, Vermont, 2010,

    With regard to fluoride and the bone they say:
    “Epidemiological Studies
    At least nineteen studies (three unpublished, including one abstract) since 1990 have examined the possible relationship of fluoride in water and hip fractures among the elderly. Eleven of these studies found an increased hip fracture rate; eight did not. Thus, to claim, as some proponents do, that there is no evidence that hip fractures are increased in fluoridated communities is inaccurate and misleading. A more accurate statement is that the evidence is mixed. (My emphasis) An annotated list of references to all nineteen studies is given in appendix 2.” (p.175)

    Ten years earlier Connett addressed this issue as follows:
    “5. So what does one do in the situation where epidemiological studies produce mixed results. One answer which is achieving growing support among a number of European governments and non-governmental organizations is to apply the Precautionary Principle. Wrapped up in this principle are four questions, which when addressed should resolve the issue of whether a population should be knowingly exposed to a toxic substance or process. These four questions are:
    • What is the weight of evidence from all the studies (e.g. biochemical, animal, tissue culture and epidemiological) on the debated outcome of concern?
    • How serious is the outcome of concern if you proceed with the course of action?
    • How large is the benefit being pursued?
    • Are there satisfactory alternatives to the course of action proposed which would avoid the outcome of concern?”

    (Ref. http://www.fluoridealert.org/content/ifin-138/ for his additional analysis)

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  2. See The Case Against Fluoride – How hazardous waste ended….

    Why? Why that particular article?

    Ten years earlier Connett…

    Who?

    (Ref. http://www.fluorblahblah

    And then you link to a blog. Great. Hugely unimpressive.

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  3. Ross, I specifically took the example of Bryson’s The fluoride Deception which did not give a balanced view or critically consider the one paper he used. As for knowledge being ambiguous, surely this was discussed by Phipps et al. The issue is complex and studies should not just be cherry picked and taken at face value. There are reasons why published conclusions are ambiguous. That is what I mean by critical analysis. Bryson didn’t apply that analysis, neither did our local council – but why should we expect them to. They do not have the background.

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  4. It can easily be established that flouride is bad for the bones.

    1. Bones contain calcium
    2. Calcium is contained in milk
    3. Fluoridated water is not milk
    Sub-conclusion
    4. Fluoridated water does not provide calcium
    Concluding
    5. Fluoridated water will destroy bones

    The logic is indisputable and undeniable,

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  5. William L C?
    Ah, I see what you did there. Well played.😉

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  6. Trevor Nutter

    I note you often use the term ‘cherry picking’ which I take to mean extracting parts of studies to support a point of view. If that is the case then surely the pro lobby has been doing just that since the 1940s and still are. The Waikato DHB cite the 2000 York review as the bees knees of evidence in favour of CWF and yet the Chair of the review panel bagged the British Dental Ass. for cherry picking the review. You obviously want your cake and eat it as well. There are many other examples of such obfuscation and bare faced deceit.
    The WDHB also categorically answer no to the question as to added fluoride being a waste product of the fert industry. My information direct from Farmers Fertiliser in Taranaki is that it is a by-product of manufacturing fertiliser. It is not therefore a natural product and the DHB answer is therefore designed to mislead.
    The DHB also claims the additive is manufactured to ‘exacting quality and purity standards’. That is also designed to mislead given that Hfa is recovered in a 4 step process that simply involves dilution of the recovered waste and removal of silica. If you have to blatantly spin an argument you deserve to lose and that is what is happening with fluoride. I note another city in the USA has rejected fluoride this week, Israel is stopping the practise next year and Ireland’s politicians are debating the issue on the back of 25 counties voting against it. Globally over 50 communities since last Christmas have rejected CWF.
    You and your mate Cedric can fluff and fart around the facts until the moon turns into cheese but that won’t stop the tide of change that is running in favour of common sense and realism.

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  7. It is semantics, but a by product that is dumped as waste is a waste product. A by product that is marketable and has a use is not waste. In some places phosphate is a by product of the fluoride industry.

    Water treatment chemicals, including ones used for fluoridation, must pass regulations for concentration and contaminants. Water treatment plants do not put any old chemical in their water. If you bother to check the certificate of analysis for the last batch of fluorosilicic acid used in Hamilton you might be shocked to discover the misinformation you have been fed by your anti-fluoridation activist friends. Ask Pat McNair for a copy – she has one but has not made it available to her group.

    As for turning tides, shall we wait to hear the results of the Hamilton Referendum before making such judgments.

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  8. Ken,

    If the medical science on this issue is complex and ambiguous why did you title this blog “Fluoridation: the hip fracture deception” and use the word ‘myth’ in your analysis?

    Surely that displays the same kind of bias you accuse others of adopting.

    There is enough information above to signify that there’s a continuing debate on the issue.

    Why not a more neutral title:
    ‘Fluoridation: hip fracture effect not yet fully settled’?

    Connett is right to advocate the precautionary principle.

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  9. Ross, this is an article using the example of Bryson’s book “The fluoride deception” – hence my use of the worked “deception” as an irony because that book promotes deceptions.

    The hip fracture claim is often repeated, probably because the users have read Bryson’s book. It is just not true, not supported by the evidence. You might wish to debate that but the point is that to do so your have to approach the literature critical and intelligently – not just declare that it is debatable. Bryson did not use that approach, he cherry picked.

    The current scientific evaluation would probably be that there is no convincing evidence indicating increased risk of hip fractures at fluoridation concentration, but there is at lower and higher concentrations. (That is my own evaluation but I do mention my limited background in this area). I don’t think anti-fluoridation activists make that distinction at all, and I am sure the Hamilton City Council didn’t – because they did not evaluate the literature.

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  10. If that is the case then surely the pro lobby has been doing just that since the 1940s….

    Two problems here.
    One: this is a Tu Quoque Argument.
    Just because “the other guy” is maybe doing the same wrong thing doesn’t somehow let you off the hook.
    Second: it’s not the “pro-lobby”. That’s pejorative framing.
    This is not between “pro” and “anti” where there’s some vague equality and (goshdarnit) it’s all confusing and up in the air..
    No.
    It’s the overwhelmingly global scientific consensus versus some tiny group of nutjobs with blogs with hard-ons for the 40’s.

    …but that won’t stop the tide of change that is running in favour of common sense and realism.

    Now that you’ve counted your chicken, all you have to do is sit back and relax until they hatch. Lucky you.
    No.
    This ploy won’t work.
    Creationists, vaccine deniers and climate deniers do the same thing.
    Leave your crystal ball at home and focus on the real world.

    Claim CA110:
    Evolution is a theory in crisis; it will soon be widely rejected.

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  11. The WDHB also categorically answer no to the question as to added fluoride being a waste product of the fert industry. My information direct from Farmers Fertiliser in Taranaki is that it is a by-product of manufacturing fertiliser. It is not therefore a natural product and the DHB answer is therefore designed to mislead.

    Poor Trevor Crosbie, aka Trevor Nutter.
    He is still struggling to understand difference between by-product and waste, and now wants to throw “natural product” into the mix for added confusion.

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  12. Trevor Nutter

    Richard – I am probably more comfortable being poor than you are being a Dick.
    Like Ken and the great Katesby you are very adept at diverting an argument into blind alleys. Why cannot the WDHB, who are simply the delivery point for the mantra of ‘safe, beneficial and cost effective past down to them from the MoH and the National Fluoride (dis)Information Service, cite the research to prove their stand. The fact is that they cannot produce what doesn’t exist and instead must rely on cherry picked ‘evidence’ from the York Review, SCHER and other reviews that when checked all say the same thing – more research into the possible detrimental outcomes of CWF is needed. Given that only about 1 percent of artificially fluoridated water is ingested and any beneficial outcomes of the process has not been scientifically established it makes sense to my poor mind to adopt a precautionary position and leave water unfluoridated until the research is done.

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  13. <i.Like Ken and the great Katesby you are very adept at diverting an argument into blind alleys.

    It wasn’t my squirrel.

    Mr Nutter, not only are challenged in the comprehension of words in the English language but you are equally challenged in the area of stringing together a logical argument.

    As Cedric points out to other science deniers who chance their hand in here, this is the internet stupid. We can just scroll up and read who raised the topic.

    As usual, you lose.

    btw, please use my correct name, after all, I use yours.

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  14. Ken, You say that the current scientific evaluation would probably be that there is no convincing evidence indicating increased risk of hip fractures at fluoridation concentration, but apparently on the basis of the Swedish study, there is at lower and higher concentrations.
    The authors say that chronic fluoride exposure from drinking water does not seem to have any important effects on the risk of hip fracture in the investigated exposure range.
    Because the full paper is behind a paywall I am unable to determine if there had been any adjustment for confounding factors such as the fact that the first city in Sweden to fluoridate was Norrköping in1952 and all fluoridation ended in Sweden in 1971. There was a one-year hiatus between 1961 and 1962 – just 18 years of fluoridation. Hamilton has been fluoridated since the 1960s – well over twice as long.
    The cohort assessed in Sweden were individuals born in the first two decades of last century. The oldest in the cohort would have been without fluoridation for 53 years.
    It is interesting that Cedric Katesby refers to Connett et al. The Case Against Fluoride as an ‘article’. If he believes that he is oblivious to much fluoridation literature. It is in fact a 372 page text co-written by three highly qualified academics. There are 1,191 endnotes over pages 291-355.
    In praise of the book, published just three years ago, Arvid Carlsson, Nobel Laureate in Medicine or Physiology (2000) and Emeritus Professor of Pharmacology, University of Gothenburg says: “Sweden rejected fluoridation in the 1970s, and in this excellent book these three scientists have confirmed the wisdom of that decision. Our children have not suffered greater tooth decay, as World Health Organization figures attest, and in turn our citizens have not borne the other hazards fluoride may cause. In any case, since fluoride is readily available in toothpaste, you don’t have to force it on people.”
    If Cedric Katesby has a more authoritative reference supporting his point of view, with equally high expert praise, I would like to hear of it.
    Professor Sir Peter Gluckman, in response to an Official Information Act request, could not provide case-controlled studies, cohort studies or intervention studies to support his published conclusion that fluoride science is essentially settled but this is what we should be demanding from the public health agencies. Don’t you agree Ken?

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  15. Ross, being behind a paywall just means you have to pay. It does not mean it’s hidden. If you are really interested you will pay for a copy or get it through your institution. Don’t pretend the paywall prevents you from reading the details.

    I am not interested in discussing the details of that Swedish study because my article is essentially about Bryson’s book and the way people treat it is a gospel. Such publications require intelligent and critical analysis. It doesn’t take much work, as I have shown, to find far better studies that Bryson ignored.

    My interpretation from the abstract of the Swedish paper is that the study had nothing to do with fluoridation but used individuals living in areas where the natural concentration of fluoride varied. There is other work which shows higher risk of bone fractures at low and higher concentrations with a minimum around the concentration used in fluoridation.

    When are you guys going to learn that testimony is not evidence. Connett’s book should be judged on the work he has done, not on the testify in the book blurbs. Nor should the number of endnotes and number of citations be relevant. I usually interpret such recommendations as a sign that the writer hasn’t even read the book.

    Now why should an OIA request be made to Gluckman on fluoride? He has not done work in this area. He doesn’t have documents of data in this area. He has the same access to the literature you have. Get off your backside and do the literature searches yourself. Don’t pretend that anyone is hiding something from you. OIA requests in a such situations are just political ploys. Even you talk about insisting on evidence from health agencies – well why then submit OIA applications to Gluckman?

    Gluckman’s blog statement that the fluoride research was effectively settled is just as statement of the current position. Several science organisations have pointed out that there is no justification for another expensive review at this stage because there is no radical new information. If and when there is would be the time for such a review.

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  16. It is in fact a 372 page text co-written by three highly qualified academics. There are 1,191 endnotes over pages 291-355.

    You mean….it’s a book?
    Oh, well that makes a huge difference.
    Not.
    Is there some special reason why you feel compelled to mention the page numbers and how many endnotes there are?
    The numbers might impress you but they don’t send a thrill up my leg.
    372 pages?
    Imagine how much more awesome 391 pages would be?
    Hmm.

    No, that won’t do at all.
    I don’t get my science information from some book or other.
    I have a much better methodology.
    Much, much, better.

    Science Works! How the Scientific Peer Review Process works

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  17. I have read Connett et. al from cover to cover. I also viewed Cedric’s ‘Science works!’ video above and don’t fault it but how does that nullify well-referenced text books which review the wide range of peer-reviewed literature in a field and provide robust summaries for a wider audience.

    If three holders of Ph.Ds with expertise in environmental chemistry, toxicology, medicine, biophysics and biological sciences can’t do that with integrity in respect to fluoride who can? Certainly not me or Cedric Katesby or Ken Perrott.

    I have also been off my backside and researched much of the fluoride literature personally and I I know Gluckman had access to a portion of that before his ‘essentially settled’ blog because I sent it to him at the time he was asked to contribute to preparation of the HCC fluoridation tribunal.

    That included PDFs of the full York Review plus appendices, the executive summary of Fluoride in Drinking Water (2006) and link to the slweb bibliography on fluoride literature so to me his ‘essentially settled’ conclusion is wrong.

    Ken, you started with Bryson and I finish with Connett so I’ll leave it at that.

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  18. Strange, though, Ross in that you still rely in empty endorsements of Connett’s book, rather than its science content.

    If you have sent material to Gluckman, why are you using an OIA application to get that information. Weird. I still think he is the last person to get the information you requested from. Again weird.

    Hey, Ross, before you go do you know where I can get an electronic copy if Connett’s book? Can’t find it anywhere and have no desire for a pBook version – especially if I have to buy it off the local anti-fluoride activists.

    Wouldn’t mind reviewing the book. Bryson’s was a flop, after all the recommendations I had. Don’t want to judge Connett without reading his book and we do have a similar professional background.

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  19. I also viewed Cedric’s ‘Science works!’ video above and don’t fault it but how does that nullify well-referenced text books…

    Maybe you should watch the video again.
    He doesn’t make a special exception for books. “Well-referenced” or otherwise. The methodology is very clear.

    If three holders of Ph.Ds with expertise….

    No.
    Watch the video. He brings up this very point right at the beginning.

    “Ordinary people in this country have the idea that science is embodied by experts and if you have a degree in something then that means you are an expert.And if somebody else has a degree in science then he’s an expert. If two experts disagree then, first of all, you don’t know what to think.”

    Simple, yeah?
    Which brings us back to you…

    There is enough information above to signify that there’s a continuing debate on the issue.

    No, keep watching the video.
    It’s specifically aimed at people like you and the way you argue.
    There is no “debate”.
    There’s no “debate” over Evolution.
    There’s no “controversy” over the risk of cancer from tobacco.
    There’s no “doubt” over the efficacy of vaccines.
    Scientists don’t have any “splaining” to do over climate change.

    The next time some bigshot on the internet tries to sell that kind of snake oil to you, tell them to enter the scientific arena or shut their pie hole.
    In science, only the work counts.
    All of it.

    Abandon the personalities. Don’t go gaga over someone (anyone) with a whoopydoo degree or glittering awards.
    Change your methodology.
    Watch the video.

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  20. Connett et al. (2010)

    There is a Kindle eBooks edition for USD13.99 at:
    http://www.amazon.com/s/ref=nb_sb_noss_1?url=node%3D154606011&field-keywords=The+Case+Against+Fluoride

    Kobo also have an eBook edition for USD19.49 at:
    http://store.kobobooks.com/en-nz/Search?Query=The+Case+Against+Fluoride

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  21. I was hoping for something cheaper than this. I am not made of money.

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