The influence of lifelong exposure to environmental fluoride on bone quality in humans

The objective of this study was to determine if lifelong exposure to environmental sources of fluoride (including fluoridated water) had an effect on bone quality in humans. Ninety-two femoral heads were obtained from individuals undergoing total hip arthroplasty in regions with and without fluoridated water (Toronto and Montreal, respectively), so that the donors would have had a wide range of fluoride exposure. As the samples were obtained at surgery, the femoral heads were affected by osteoarthritis (75), osteoporosis (9) and other diseases. The fluoride content of cancellous bone was assessed by instrumental neutron activation analysis. A number of contributors to bone quality were assessed. The compressive and torsional mechanical properties were measured for cancellous cores excised from the centre of the femoral head. The architecture was assessed by image analysis of an x-ray of a 5 mm thick coronal section of the femoral head, as well as of histological sections taken from the superior (weightbearing) and the inferior (nonweightbearing) surface of the femoral head. The degree of mineralization was measured using backscattered electron imaging and microhardness, again at the superior and the inferior surface.; Femoral heads from Toronto donors had a greater mean fluoride content than those from Montreal donors (1033 ± 438 ppm vs. 643 ± 220 ppm). However, the fluoride content of the Toronto donors ranged approximately twelve-fold (192–2264 ppm) and entirely contained the range of Montreal donors. Therefore, fluoridated water exposure is not the only determinant of fluoride content. The logarithm of the bone fluoride content increased with age. No substantive effect of fluoride, independent of age, was observed for the mechanical properties. Similarly, at the inferior surface, the architecture was affected by age but not by fluoride incorporation but the degree of mineralization was not affected by either. However, the degree of mineralization (measured by both backscattered electron imaging and microhardness) at the superior surface increased linearly with the fluoride content. As osteoarthritis results in a reduced degree of mineralization at the superior surface, this suggests that the presence of fluoride (which increases the degree of mineralization in osteoarthritis-affected bone) may aid in preventing this loss.