Alarming increase in fluoride intake

October 20 is World Osteoporosis Day

Fluoride was till a few years ago being used as a chemical for treating osteoporosis as it was known to increase bone mass. Several studies have however revealed a deadly side-effect: it increases the chances of bone fractures, especially of the hips.

Fluorosis is a disease caused by excessive ingestion of fluoride through water and or food. The upper limit of optimum fluoride level in drinking water for a tropical country like India is 0.5 PPM or 0.5 Mg/l. China fixed 0.7 PPM as upper safe limit in drinking water. It is the total daily intake through water and food that determines the development of fluorosis.

Nearly all foods contain fluoride and the upper limit of safe total intake of fluoride from water and food per day for an adult is 8 mg. Fluorosis takes four forms dental, genu valgum, skeletal and neurological. Nalgonda district in Telangana State is one such region where high concentration of fluoride is present in groundwater. Weathering of rocks and evaporation of groundwater are responsible for high fluoride concentration in groundwater of this area apart from anthropogenic activities including irrigation which accelerates weathering of rocks.

"Fluoride has been used in the past on many an occasion and is possibly one of the oldest drugs available for managing osteoporosis," Gurinder Bedi, senior consultant, department of orthopedics, spine surgery and joint replacement, Fortis Hospital, Vasant Kunj, told IANS.

"Its use would actually produce dramatic effects in changing the radiographic appearance of bones making them appear much denser, quicker than any of the other agents. The actual bone mass seemed to increase but it did not promote any mineralisation (depositing of calcium) resulting in poor bone quality and hence chances of fractures are high," he said. Osteoporosis is a disease of the bone due to loss in peak bone mass and calcium, leading to hip, knee and shoulder fractures.

According to the International Osteoporosis Foundation, the number of patients in India in 2003 was approximately 26 million, with the numbers projected to increase to 36 million by 2013. Another expert, Vivek Logani, said: "It is widely recognised that fluoride therapy for osteoporosis adds mass to bones but produces inferior bones. In short, the bio-mechanical competence of the skeleton may be compromised because the tensile (elasticity) strength of bone is sacrificed."

"Numerous studies show that fluoride may cause not only increased skeletal fragility (more non-vertebral fractures such as hips) but also osteomalacia (deficiency of bone mineralization)," Logani, chief of joint replacement surgery at Gurgaon's Paras Hospital, told IANS. "Due to this unclear mechanism of action and well- proven counterproductive action of fluoride on the strength and elasticity of the bone, the (US) Food and Drug Administration has rejected the use of fluoride for treatment of osteoporosis," Logani added. According to experts, lower body pain, prolonged pain, non-response to ordinary medication, body stiffness and inability to walk are symptoms of bones being affected by high fluoride concentration.

Logani said in India, fluoride concentration is also found in water derived from deep bore wells. People consuming between 2 to 8 mg of fluoride/day (2 to 8 litres of fluoridated water) can develop certain symptoms of bone diseases, not particularly osteoporosis.

Experts stress on drinking filtered water, limiting consumption of soda, reconstituted fruit juice, beer wine, tinned fish, deboned chicken in any form, including chicken nuggets and canned chicken, and baby food. They also advise eating fresh food, reducing the consumption of black and green tea and not using non-stick pans. "With toothpastes almost universally containing fluoride as an additive, consider using unfluoridated toothpaste. If you use a fluoridated toothpaste, rinse your mouth well with water after brushing your teeth. Make sure kids don't swallow the rinse," Harshvardhan Hegde, medical director, Nova Orthopedic and Spine Hospital, told IANS.