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Christa Danielson, MD; Joseph L. Lyon, MD; Marlene Egger, PhD; Gerald K. Goodenough, MD

JAMA. 1992;268(6):746-748.

Abstract
Objective.
—To test the effect of water fluoridated to 1 ppm on the incidence of hip fractures in the elderly.

Design.
—Ecological cohort.

Setting.
—The incidence of femoral neck fractures in patients 65 years of age or older was compared in three communities in Utah, one with and two without water fluoridated to 1 ppm.

Patients.
—All patients with hip fractures who were 65 years of age and older over a 7-year period in the three communities, excluding (1) those with revisions of hip fractures, (2) those in whom the hip fracture was anything but a first diagnosis, (3) those in whom metastatic disease was present, or (4) those in whom the fracture was a second fracture (n=246).

Outcome Measure.
—Rate of hospital discharge for hip fracture.

Results.
—The relative risk for hip fracture for women in the fluoridated area was 1.27 (95% confidence interval [CI]=1.08 to 1.46) and for men was 1.41 (95% CI=1.00 to 1.81) relative to the nonfluoridated areas.

Conclusions.
—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.

(JAMA. 1992;268:746-748)

Author Affiliations
From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City.

Footnotes
Reprint requests to the Department of Family and Preventive Medicine, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132 (Dr Danielson).

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