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Exposure to fluoride in drinking water and hip fracture risk: a meta-analysis of observational studies.
PLoS One 2015; 10(5):e0126488Plos

Abstract

BACKGROUND

Many observational studies have shown that exposure to fluoride in drinking water is associated with hip fracture risk. However, the findings are varied or even contradictory. In this work, we performed a meta-analysis to assess the relationship between fluoride exposure and hip fracture risk.

METHODS

PubMed and EMBASE databases were searched to identify relevant observational studies from the time of inception until March 2014 without restrictions. Data from the included studies were extracted and analyzed by two authors. Summary relative risks (RRs) with corresponding 95% confidence intervals (CIs) were pooled using random- or fixed-effects models as appropriate. Sensitivity analyses and meta-regression were conducted to explore possible explanations for heterogeneity. Finally, publication bias was assessed.

RESULTS

Fourteen observational studies involving thirteen cohort studies and one case-control study were included in the meta-analysis. Exposure to fluoride in drinking water does not significantly increase the incidence of hip fracture (RRs, 1.05; 95% CIs, 0.96-1.15). Sensitivity analyses based on adjustment for covariates, effect measure, country, sex, sample size, quality of Newcastle-Ottawa Scale scores, and follow-up period validated the strength of the results. Meta-regression showed that country, gender, quality of Newcastle-Ottawa Scale scores, adjustment for covariates and sample size were not sources of heterogeneity. Little evidence of publication bias was observed.

CONCLUSION

The present meta-analysis suggests that chronic fluoride exposure from drinking water does not significantly increase the risk of hip fracture. Given the potential confounding factors and exposure misclassification, further large-scale, high-quality studies are needed to evaluate the association between exposure to fluoride in drinking water and hip fracture risk.

Authors+Show Affiliations

Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.Department of Oral and Maxillary Surgery, Gui Zhou provincial people's hospital, Guiyang, Gui Zhou, PR China.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

26020536

Citation

Yin, Xin-Hai, et al. "Exposure to Fluoride in Drinking Water and Hip Fracture Risk: a Meta-analysis of Observational Studies." PloS One, vol. 10, no. 5, 2015, pp. e0126488.
Yin XH, Huang GL, Lin DR, et al. Exposure to fluoride in drinking water and hip fracture risk: a meta-analysis of observational studies. PLoS ONE. 2015;10(5):e0126488.
Yin, X. H., Huang, G. L., Lin, D. R., Wan, C. C., Wang, Y. D., Song, J. K., & Xu, P. (2015). Exposure to fluoride in drinking water and hip fracture risk: a meta-analysis of observational studies. PloS One, 10(5), pp. e0126488. doi:10.1371/journal.pone.0126488.
Yin XH, et al. Exposure to Fluoride in Drinking Water and Hip Fracture Risk: a Meta-analysis of Observational Studies. PLoS ONE. 2015;10(5):e0126488. PubMed PMID: 26020536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exposure to fluoride in drinking water and hip fracture risk: a meta-analysis of observational studies. AU - Yin,Xin-Hai, AU - Huang,Guang-Lei, AU - Lin,Du-Ren, AU - Wan,Cheng-Cheng, AU - Wang,Ya-Dong, AU - Song,Ju-Kun, AU - Xu,Ping, Y1 - 2015/05/28/ PY - 2014/04/28/received PY - 2015/04/06/accepted PY - 2015/5/29/entrez PY - 2015/5/29/pubmed PY - 2016/4/2/medline SP - e0126488 EP - e0126488 JF - PloS one JO - PLoS ONE VL - 10 IS - 5 N2 - BACKGROUND: Many observational studies have shown that exposure to fluoride in drinking water is associated with hip fracture risk. However, the findings are varied or even contradictory. In this work, we performed a meta-analysis to assess the relationship between fluoride exposure and hip fracture risk. METHODS: PubMed and EMBASE databases were searched to identify relevant observational studies from the time of inception until March 2014 without restrictions. Data from the included studies were extracted and analyzed by two authors. Summary relative risks (RRs) with corresponding 95% confidence intervals (CIs) were pooled using random- or fixed-effects models as appropriate. Sensitivity analyses and meta-regression were conducted to explore possible explanations for heterogeneity. Finally, publication bias was assessed. RESULTS: Fourteen observational studies involving thirteen cohort studies and one case-control study were included in the meta-analysis. Exposure to fluoride in drinking water does not significantly increase the incidence of hip fracture (RRs, 1.05; 95% CIs, 0.96-1.15). Sensitivity analyses based on adjustment for covariates, effect measure, country, sex, sample size, quality of Newcastle-Ottawa Scale scores, and follow-up period validated the strength of the results. Meta-regression showed that country, gender, quality of Newcastle-Ottawa Scale scores, adjustment for covariates and sample size were not sources of heterogeneity. Little evidence of publication bias was observed. CONCLUSION: The present meta-analysis suggests that chronic fluoride exposure from drinking water does not significantly increase the risk of hip fracture. Given the potential confounding factors and exposure misclassification, further large-scale, high-quality studies are needed to evaluate the association between exposure to fluoride in drinking water and hip fracture risk. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26020536/Exposure_to_fluoride_in_drinking_water_and_hip_fracture_risk:_a_meta_analysis_of_observational_studies_ L2 - http://dx.plos.org/10.1371/journal.pone.0126488 DB - PRIME DP - Unbound Medicine ER -