Water Fluoridation and Hip Fracture

To the Editor. — In a recent article inThe Journal, Jacobsen et al1demonstrated a positive ecologic association between hip fracture discharge rates in the United States and fluoride content in water supplies. In a similar study, we recently reported the ecological association of discharge rates for hip fracture and water fluoride levels in 39 county districts in England.2Our study was performed in response to the suggestion that fluoridation of water might serve to stem the rising tide of hip fracture in western populations. Such a strategy was supported by laboratory evidence that fluoride was a potent inducer of bone formation, and by epidemiologic studies from Finland and the United States demonstrating lower rates of hip fractures associated with higher water fluoride levels. Our analysis demonstrated no significant association between discharge rate and total fluoride concentration (r=.16,P=.34). This lack of association was found