Osteoporosis is a bone disease that causes a reduction in bone mineral density (BMD), resulting in fragile bones and increasing the risk of fractures.

It affects about 200 million people worldwide and is associated with long lasting reduced quality of life and increased mortality.

Some of the most common locations for osteoporosis-induced fractures are the hips, forearms, and vertebrae — the small bones that make up your spinal column.

While anyone can get osteoporosis, some people are more likely to develop it than others. For example, the disease is more common in people who:

  • were assigned female at birth
  • are older than age 50
  • are postmenopausal and are not taking hormone replacement therapy
  • have low calcium levels
  • smoke tobacco products
  • engage in low levels of physical activity
  • drink more than three alcoholic beverages per day
  • have low body weight
  • are using certain long-term medicinal therapies

Osteoporosis currently has no cure. However, multiple nutrients, including fluoride, positively affect bone health, and researchers have been experimenting with fluoride supplementation as a possible treatment for years.

Here’s what the latest evidence has to say about the role of fluoride in osteoporosis.

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Fluoride is a mineral that’s responsible for preventing dental cavities and stimulating bone formation — hence the scientific community’s interest in its potentially beneficial role in osteoporosis treatment.

Your gastrointestinal tract can absorb up to 80% of the fluoride you ingest. Children tend to retain more fluoride because their bones are still developing — they retain up to 80% of the fluoride they take in, while adults retain only 50%.

Fluoride intake primarily comes from fluorinated water or foods and drinks made with fluorinated water. However, there are natural sources as well, such as seafood, black and green teas, and wine.

First things first: Your bones are constantly being remodeled through a balanced process that involves the activity of two types of bone cells called osteoclasts and osteoblasts.

Osteoclasts are in charge of bone resorption — meaning that they break down bone tissue to release its minerals into the bloodstream. In contrast, osteoblasts are in charge of bone formation.

To ensure that this process is successful, osteoblast and osteoclast activities must be well balanced. However, osteoporosis is characterized by increased osteoclast function, ultimately leading to fragile and brittle bones.

Some vitamins and minerals, such as fluoride, can help support bone remodeling. According to a recent research review, fluoride may help protect against osteoporosis by:

  • stimulating osteoblast activity and quantity
  • inhibiting osteoclast activity
  • increasing the level of bone cell growth factors such as insulin-like growth factor–1 (IGF-1) and osteoblastic transforming growth factor-beta 1 (TGF-β1)

Furthermore, a recent meta-analysis found that a daily dose of at least 20 mg of fluoride equivalents was linked with a significantly decreased risk of fractures and that fluoride treatment resulted in a higher BMD.

The researchers also determined that women who consumed fluorinated water had a 31% and 27% lower risk of hip and vertebral fractures, respectively, than those who drank non-fluorinated water.

Still, despite these promising findings, there’s conflicting evidence — from both older and newer research — on fluoride’s effect on fracture risk.

It’s possible to have too much of a good thing

Regardless of fluoride’s role in bone health, excessive long-term intake of this mineral can actually be detrimental to your bones by causing skeletal fluorosis.

Skeletal fluorosis is a condition that can lead to joint pain or stiffness, muscle weakness, neurological problems, and even osteoporosis.

Older research suggests that higher rates of bone fracture follow fluoride supplementation.

Moreover, a 2021 study based on older research suggests that while fluoride increases BMD and stimulates bone formation, those bones are of lower quality and can easily break.

Similarly, a 2021 review suggests that excessive fluoride intake can disturb bone metabolism, resulting in an imbalance between bone formation and bone resorption.

Therefore, researchers emphasize that it’s important for the medical community to determine an appropriate dose of fluoride for humans, considering that the difference between a tolerated dose and a harmful dose seems to be small.

To help prevent people from unintentionally consuming excess fluoride, the Food and Drug Administration lowered the permissible level of fluoride added to bottled water to 0.7 mg/L.

Evidence indicates that many people with osteoporosis may benefit from maintaining a generally healthy lifestyle that includes the following:

  • strength or resistance training to promote stronger bones and improve coordination and balance
  • avoidance of tobacco smoking and secondhand smoke
  • limited alcohol use
  • a nutritious, balanced diet
  • precautions to prevent falls, such as wearing shoes that provide support or using a cane if needed
  • daily supplements of calcium and vitamin D, if recommended or approved by a healthcare professional

Additionally, research suggests that supplementing with certain nutrients can positively affect your bones by preventing potential deficiencies.

Some of the most important micronutrients for osteoporosis are calcium, vitamin D, magnesium, zinc, manganese, boron, iron, copper, silicon, and selenium.

Furthermore, people following vegetarian diets should pay special attention to their vitamin B12 levels and protein intake. Both nutrients play a role in bone health but are often lacking in meatless diets.

Be sure to talk with a healthcare professional before adding supplements to your diet.

Osteoporosis is a disease characterized by low BMD, which leads to fragile and brittle bones.

Given fluoride’s role in bone formation, research suggests that supplementing with it might be beneficial for treating and preventing the disease.

While recent research supports fluoride supplementation to increase BMD and reduce the risk of fractures, results are still mixed, as both older and more recent studies suggest that it can do more harm than good.

In the meantime, people with osteoporosis may benefit from maintaining a generally healthy and active lifestyle.

In some cases, supplementation with vitamins and minerals aside from fluoride might be necessary, but it’s important to check in with a healthcare professional before starting any supplements.