Pennsylvania Sierra Club Opposes State Fluoridation Effort

by Michael Evers

The Pennsylvania Chapter of the Sierra Club, The Ray Proffitt Foundation, and Zero Waste America held a press conference in the State Capitol Rotunda August 12 calling for a ban on adding fluoride to municipal water. As cause for their action, environmentalists cited the recent announcement of a campaign to fluoridate Pennsylvania by the State Dept. of Health, and the July 2, 1997 unanimous vote against the practice of fluoridating municipal water, by the 1100 members of Environmental Protection Agency's National Federation of Federal Employees (NFFE). These are the scientists, engineers, and attorneys who assess the scientific data for EPA regulations. (See NHL 07.21.97) NFFE's press release stated, "Our members' review of the body of evidence over the last 11 years, including animal and human epidemiology studies, indicate a causal link between fluoride/fluoridation and cancer, genetic damage, neurological impairment, and bone pathology. "Of particular concern are recent epidemiology studies linking fluoride exposure to lowered IQ in children. As the professionals who are charged with assessing the safety of drinking water, we conclude that the health and welfare of the public is not served by the addition of this substance to the public water supply." In response to accusations that they used outdated and discredited studies, the environmental organizations cited recent government and dental association documents as the basis for their decision to call for a fluoride ban. "Together with many other studies published over the last several years, we focused on four studies published in the Journal of the American Dental Association JADA (June 1995, Dec. 1995, July 1996, July 1997), the revised fluoride supplementation dosage schedule and recommendations from the American Dental Association's (ADA) Council on Scientific Affairs (JADA, April 1994), the Academy of General Dentistry's Dec. 1996 release: Fruit Juices May Foster Fluorosis in Children, the 1993 EPA Fact Sheet (Fluoride in Drinking Water), reports by the U.S. Dept. of Health and Human Services (A Toxicological Profile-1993 and Review of Fluoride Benefits and Risks- 1991), and NFFE testimony at 1991 EPA hearings," said Lynn Landes, chair of the Pa. Sierra Fluoride Committee. According to these publications, Americans are over-exposed to fluoride. In the mid-1940's, the federal government determined that one milligram per day (1 mg/liter) was the optimal dosage of fluoride for teeth. In 1985, the standards were raised to allow up to 4 mg/liter in municipal water. Today, Americans are receiving 2-7 times the standard 1 mg optimal dosage, Landes said. According to the EPA, above 2 mg/liter, children are likely to develop dental fluorosis (discoloration & white flecks) and above 4 mg/liter, humans are at risk for crippling skeletal fluorosis. These reports of over-exposure have not changed the pro-fluoride policies of the federal government or the dental community. The contradictions between policy, reports, and recommendations are numerous. In 1994, The American Dental Association (ADA) recommended that dentists and doctors take a complete fluoride (exposure) history of patients before prescribing fluoride supplements for children. That is an impossible task. Fluoride is in unlabeled processed food and beverage products, fluoridated water, dental products, pharmaceuticals, and workplace emissions. The ADA also advised no fluoride supplements for children exposed to greater than 0.6 mg/liter fluoride in municipal water. However, HHS had already determined in 1991, that Americans living in unfluoridated communities are receiving at least 0.8 mg/liter from food, beverages, and other sources. At this level of exposure, it would appear that fluoride supplements are no longer needed in the U.S. Last December, the Academy of General Dentistry issued a press release warning parents to limit their children's intake of fruit juices due to excessive levels of fluoride. Interestingly, the fluoride content of the juices was well within federal legal limits of 1-4 mg/liter. In July 1997, The Journal of the American Dental Association published a study that reported fluoride levels in excess of 8 mg/liter in chicken food for infants. It is against EPA regulations for water to contain above 4 mg/liter. "Baby boomers will be the first generation of Americans to experience a life-time of over-exposure to fluoride. The Pa. Chapter of the Sierra Club is concerned that the cost to public health and the environment will rival our experience other contaminants. "We have taken a responsible position against fluoride. We encourage the Pa. Legislature to do the same," said Landes. For more information, J. William Hirzy, PhD Senior Vice President NFFE, Local 2050 P.O. Box 76082 Washington, DC 20013 (202) 260-2383 (202) 401-3129 fax Citizens for Safe Drinking Water 3243 Madrid Street San Diego, CA 92110 (800) 728-3833 (619) 222-6981 fax email -- jgreen@abac.com email -- dkennedy@ucsd.edu Also visit http://www.sonic.net/~monty/fluoride.htm Sodium fluoride applied to the enamel surface creates an ion exchange with calcium. The resulting calcium fluoride is incorporated into the developing surface of the growing tooth and results in a hardened surface. This fact is a plus to the patient, and stands as the only one which supports the use of sodium fluoride at all. Connected with some of the other items listed, it also serves as a "con" to the ingestion of sodium fluoride, and/or to the application of topical sodium fluoride to the teeth of adults, since neither produces this hardening effect. --Noel Taylor Poison Warnings on Toothpaste ------------------------------- (picture of a tube of Crest, with the caption, "New warning lables are required by the Food and Drug Administration on all fluoride toothpastes and dental care products shipped as of April 7." Last month, as 8-year-old Molly Statt stood in the bathroom brushing her teeth, something on the back of the tube of Crest caught her attention. She stopped brushing. Looking up at her father standing besider her, she asked, "Is this poison?" "Of course not," Paul Statt reassured his daughter. "Then why does it say 'poison' on it?" she asked. Statt looked closer at the label. In small print were warnings he hadn't noticed before, including one that read, "If you accidentally swallow more than used for brushing, seek professional help or cantact a poison control center immediately." Caught off guard, he didn't have a good answer for Molly. For a week or so afterward, she didn't want to brush with toothpaste. Now she is back to using it, but Statt worries that she's confused about the safety of toothpaste and about the truth of poison labels. "When did they start putting a poison warning on toothpaste tubes?" he asks. Like most people, the Petersborough, NH resident assumed that an over-the-counter health-care product like toothpaste must certainly be as safe as the water we drink. But it is not. And that is the message of the new warning labels required by the Food and Drug Administration on all fluoride toothpastes and dental care products shipped as of April 7. Less than Candid None of the caveats that began appearing on toothpaste tubes in 1991 so candidly broached the risks of ingesting too much fluoride. General warnings on toothpaste products that display the American Dental Association seal of approval heretofore cautioned: "Don't Swallow - Use only a pea-sized amount for children under 6" and "Children under 6 should be supervised while brushing with any toothpaste to prevent swallowing." The word "poison" wasn't used. "When I receive the fluoride here, it has a skull-and-bones on it," Regina Miskewitz says of containers of the chemical at the Princeton, NJ laboratories of Church & Dwight Co., Inc., maker of Arm & Hammer products, where she is director of research and development for oral and personal care. "If a child was to take a big spoonful of this fluoride, I don't think he could swallow it," she says, "but if he did get it down, it is a poison and the child could die. If a child ingested a whole tube of toothpaste, he should be taken right to the emergency room and he would either get his sotmach pumped or get some kind or antidote." Three ingredients found in most toothpastes pose health risks if too much is ingested, according to Miskewitz. Sorbitol, a liquid that keeps toothpaste from drying out, is a laxative that could cause diarrhea in children. Sodium lauryl sulfate, an ingredient that makes toothpaste foam, can also be a diarrhetic. But the fluoride poses the most danger if too much toothpaste is swallowed - particularly by younger children. Fluoride is a Drug "The fluoride in toothpaste is considered a drug," Miskewitz says. "Even though it is an over-the-counter drug, we aare altering the body when we brush our teeth with a fluoride toothpaste or tooth gel....I'm sure our 800 number (on the toothpaste box) is going to get more calls as products with the new warnings show up on store shelves." This summer, as toothpaste shipments with the new labeling replace older inventories, consumers will see nearly twice the warnings displayed on the back of tubes and cartons - the ADA's general warnings along with the new FDA-required statement that starts with: "Keep out of the reach of children under 6 years of age." Research has shown that because they aren't yet in control of their swallowing reflex, chidren 4-6 years old typically swallow toothpaste when brushing. "That's why it's recommended that kids get only a pea-size amount of toothpaste," says Miskewitz, "because most of that goes down their throats." A 1995 study at the Medical College of Georgia School of Dentistry found that about half the children this age don't spit out or rinse out - they swallow the toothpaste instead. Making matters worse, they tend to use too much toothpaste on their own, expecially when they use flavored children's toothpastes. While cavity-preventing effectiveness of fluoride has been demonstrated, too much fluoride not only can be dangerious, it can cauuse a condition known as fluorosis that discolors or spots developing teeth. Research conducted by the School of Dental Medicine at the University of Connecticut Health Center concluded that brushing with more than a pea-size amount of toothpaste more than once daily contributed to most of the fluorosis cases it observed in young children. In areas where the drinking water contains fluoride, children who swallow even the pea-size amount of toothpaste are getting too much fluoride and are at risk for fluorosis. (article truncated due to typist fatigue) The following article it taken from EarthWatch News. Those of you who are practicing in Pennsylvania have the opportunity to bring your physiology and nutrition training to bear. IMHO, letters to your elected representatives and/or offers to testify would be in order. Simply pointing out the following well established facts should do very well: 1) Sodium fluoride is a toxic byproduct of the aluminum manufacturing process. 2) The human body requires calcium fluoride to strengthen teeth; sodium fluoride is an entirely different chemical. 3) Sodium fluoride applied directly to the enamel suface results in calcium fluoride formation in this portion of growing teeth, which greatly strengthens tooth surfaces and resistance to cavity formation. 4) Sodium fluoride applied directly to the enamel surface has no effect upon fully developed teeth. 5) Sodium fluoride ingested into the gastrointestinal tract of the human being has no effect upon tooth enamel. 6) The target age - childhood - is represented by a small portion of the entire population of Pennsylvania. 7) Sodium fluoride is clearly shown as an agent of early weakening and spontaneous fracture in the hips of elderly people. 8) Sodium fluoride is implicated in a host of other pathological processes, including cancer. 9) Toothpaste manufactured and sold in the US is required to carry the standard label for poison, and strong warnings regarding ingestion, if it contains sodium fluoride. 10) Sodium fluoride is a highly effective component of many commercial rat poisons. 11) Drinking water which has been used to "prove" the effectiveness of sodium fluoride in epidemiologic studies of regions with naturally occurring fluoride contains calcium fluoride, not sodium fluoride. 12) The only safe method of artificial tooth fluoridation is he topical application of the chemical by trained personnel who insure complete flushing and proscribe any swallowing during and after the application process. 13) Dental fluorosis has reached epidemic proportions in some areas of this country due to the excesses of artificial fluoridation of drinking water. 14) Baby food recalls have become necessary due to the toxic levels of sodium fluoride found in those foods processed using artificially fluoridated municipal drinking water sources. Citations from the research studies which show absence of desired effect, retrospective reviews of the fatal flaws in the celebrated "Crest Test", and epidemiologic reviews which demonstrate the adverse effects of naturally occurring fluoridation in regional water supplies should also be included. Regards.... --Noel >ID: 19970910- 3 >EARTHWATCH/Fluoride Fury >September 10, 1997 > >A Pennsylvania plan to fight cavities reopens a decades-old >debate. >---------------------------------------- >Last year, an effort to pass a mandatory fluoridation bill >died in the Pennsylvania legislature. But the state is >considering a new proposal. It would require municipal water >systems to add fluoride to drinking water as a way to fight >tooth decay. > >Opponents include some members of the National Federation of >Federal Employees who work for the U.S. Environmental >Protection Agency. The EPA itself does not oppose fluoride in >drinking water. But a number of agency employees do, >including senior scientist William Hirzy. He says >epidemiological studies show fluoride to be dangerous. > > "You've got a possible and minuscule benefit of reducing > dental cavities and you're running these risks of > elevated cancer, hip fracture, neurotoxicity, and the > balance seems way out of line to us, just way out of > line." > >Hirzy says processed foods and bottled beverages also contain >fluoride, so people are getting far more than the amount in >their drinking water. > >But American Dental Association spokesman Michael Easley says >each municipality adjusts fluoride levels to reflect these and >other factors. Easley is an associate professor of dentistry >at the State University of New York at Buffalo. He says the >evidence cited by critics does not stand up to scrutiny. > > "They've been raising these issues since the mid-'50s. > They use a laundry-list approach, they like to claim it > causes Down syndrome, heart disease, everything else that > you can imagine, and in fact when researchers then take a > very close look at it, that's not the case, so it's stood > the test of time." > >Easley says every dollar spent on water fluoridation saves 80 >dollars in dental bills. Opponents like William Hirzy dispute >those figures, citing studies that show no benefit. Here is what one judge reportedly decided after spending some time educating himself... 1992: Statement by Pennsylvania Justice Flaherty, after 40 days of court hearings on fluoride: "... I entered an injunction against the fluoridation of the public water supply for a large portion of Allegheny County. ... In my view, the evidence is quite convincing that the addition of sodium fluoride to the public water supply at one part per million is extremely deleterious to the human body, and a review of the evidence will disclose that there was no convincing evidence to the contrary." Pennsylvania Supreme Court Justice John P. Flaherty (Townsend Letter For Doctors - June 1992, p. 450) Anyone interested in the document from which this came, e-mail me and I will send it... Todd D. Gastaldo, D.C. Fluoride Warning Ordered for Toothpaste by Tom Valentine page B-9 For the past 50 years opponents of fluoridation have been called "extremist cranks" and "wackos" because they called the use of fluoride in public water supplies insanity. "Fluoride is a deadly poison," the "extremists" cried out to anyone who would listen. Smug Americans who put total faith in their government and its public servants ignored the "radicals" and not only voted to put fluoride in their water, but demanded it in their toothpaste. After all, the obedient masses were told that fluoride was good for their children's teeth. This isn't necessarily the whole truth, but obsequious Americans easily chose the institutionalized version of "science" over the "extremist cranks." After all, what are institutions for? Just three months ago the U.S. Food and Drug Administration ruled that all toothpaste containing fluoride must also wear the skull and crossbones sign of poison on the labels. The newly printed symbol of death on the tubes of toothpaste have been unsettling to Mr. and Mrs. Americe, who heretofore ignored the small print, which read, "Don't swallow - Use only pea-sized amount for children under six. Children under six should be supervised while brushing with any toothpaste to prevent swallowing." The word poison whas not used, even though there is no doubt about fluoride's deadly effects. It has been used as rat poison for decades, but only "extremist cranks" seemed to care. (segment deleted because it duplicates previously posted articles, with the additional comment about fluoride preventing cavities: "Scientific studies do not verify this claim.") While the Establishment will admit to fluorosis, it will not admit to fluoride causing cancer and brittle bones in the elderly, although competent research indicates the fact. The Spotlight's _Special Report On the Dangers of Fluoridation_, which fully describes the dangers to health of adding sodium fluoride tto water, has proven very popular. See ad page B-12. ---------------------------------------------------------------------------- ------ Title Effects of fluoride on rat vertebral body biomechanical competence and bone mass. Author S‡gaard CH; Mosekilde L; Schwartz W; Leidig G; Minne HW; Ziegler R Address Department of Connective Tissue Biology, University of Aarhus, Denmark. Source Bone, 1995 Jan, 16:1, 163-9 Abstract For more than 30 years, sodium fluoride has been a commonly used therapeutic agent for established osteoporosis because of its repeatedly documented anabolic effect on trabecular bone mass. Recent clinical and experimental studies have, however, indicated a possible detrimental effect of fluoride on bone strength. Thus, the efficacy of fluoride therapy remains a controversial issue. The aim of this study was to investigate the effect of fluoride on both vertebral bone mass and quality in rats. Twenty-nine 3-month-old, female rats were randomized into three groups. One group served as a control group, and the other two groups received fluoridated water at different doses (100 ppm and 150 ppm). The rats were followed for 90 days. Three lumbar vertebrae were obtained from each rat, and changes in bone fluoride content, bone mass and biomechanical competence were assessed. The results revealed a significant increase in bone fluoride content, ash density and trabecular bone volume after fluoride treatment. Directly obtained load values and load corrected for cross-sectional area were constant. Load corrected for ash content, which is a measure of bone quality, decreased significantly after fluoride therapy. It is concluded that the increase in bone mass during fluoride treatment does not translate into an improved bone strength and that the bone quality declines. This investigation thereby supports the hypothesis of a possible negative effect of fluoride on bone quality. Title Do men suffer with osteoporosis? Author Seeman E Address Austin and Repatriation Medical Centre, University of Melbourne. Source Aust Fam Physician, 1997 Feb, 26:2, 135-43 Abstract Osteoporotic fractures in men are a neglected public health problem. The pathogenesis of bone loss is incompletely understood but is probably due to reduced bone formation rather than increased bone resorption. Primary or secondary hypogonadism is a common and treatable cause of osteoporosis and should be excluded in all men presenting with spine or hip fractures. Alcohol excess, with or without hypogonadism, is a most important attributable risk factor for osteoporosis in men. There is no known treatment for osteoporosis in men (as there have been no clinical trials using anti fracture efficacy as an endpoint in men) and few well designed trials examining the effects of drugs on bone mineral density (BMD). Bisphosphonates, while reducing fracture rates in women, have only been shown to increase BMD in men Calcium supplementation may slow bone loss. Anabolic agents, such as nandrolone have not been adequately studied. Fluoride therapy cannot be recommended as bone strength does not appear to increase despite the well documented increase in BMD. Risk factors such as alcohol excess and tobacco use should be corrected. Title Comparison of alendronate and sodium fluoride effects on cancellous and cortical bone in minipigs. A one-year study. Author Lafage MH; Balena R; Battle MA; Shea M; Seedor JG; Klein H; Hayes WC; Rodan GA Address Merck Research Laboratories, West Point, Pennsylvania 19486, USA. Source J Clin Invest, 1995 May, 95:5, 2127-33 Abstract Fluoride stimulates trabecular bone formation, whereas bisphosphonates reduce bone resorption and turnover. Fracture prevention has not been convincingly demonstrated for either treatment so far. We compared the effects of 1-yr treatment of 9-mo-old minipigs with sodium fluoride (NaF, 2 mg/kg/d p.o.) or alendronate (ALN, 4 amino-1-hydroxybutylidene bisphosphonate monosodium, 1 mg/kg/d p.o.) on the biomechanical and histomorphometric properties of pig bones. As expected, NaF increased and ALN decreased bone turnover, but in these normal animals neither changed mean bone volume. NaF reduced the strength of cancellous bone from the L4 vertebra, relative to control animals, and the stiffness (resistance to deformation) of the femora, relative to the ALN group... In the ALN-treated animals, there was a strong positive correlation between bone strength and L5 cancellous bone volume, but no such correlation was observed in the NaF group. Furthermore, the modulus (resistance to deformation of the tissue) was inversely related to NaF content and there was a relative decrease in bone strength above 0.25 mg NaF/g bone. Moreover, within the range of changes measured in this study, there was an inverse correlation between bone turnover, estimated as the percentage of osteoid surface, and modulus. These findings have relevant implications regarding the use of these agents for osteoporosis therapy. Title Effects of sodium fluoride and alendronate on the bone mineral in minipigs: a small-angle X-ray scattering and backscattered electron imaging study. Author Fratzl P; Schreiber S; Roschger P; Lafage MH; Rodan G; Klaushofer K Address Fourth Medical Department, Hanusch Hospital, Vienna, Austria. Source J Bone Miner Res, 1996 Feb, 11:2, 248-53 Abstract Sodium fluoride (NaF), which stimulates bone formation, and bisphosphonates, which reduce bone resorption, are both used in the treatment of osteoporosis, and are binding to bone mineral. In this study, using small-angle X-ray scattering and backscattered electron imaging, we analyzed the bone mineral in the vertebrae of minipigs treated with fluoride, with the bisphosphonate alendronate (ALN), or with vehicle... All specimens were investigated blindly. A slight increase in the average thickness of the mineral crystals as well as changes in the structure of the mineral/collagen composite were found in the case of fluoride-treated animals. No differences were found between ALN-treated animals and controls. The changes produced by fluoride are in the same direction as seen in bones from patients treated with NaF, albeit much smaller. They also correlate quantitatively with the reduction in biomechanical properties of bone in fluoride-treated minipigs found in an earlier study with the same animals. These findings suggest that small changes in the structure of the mineral/collagen composite in bone may considerably affect its biomechanical properties. It also emphasizes the delicate balance between the increase of bone mass and deterioration of bone material properties for the effect of fluoride on the biomechanical properties of bone. Title Do men suffer with osteoporosis? Author Seeman E Address Austin and Repatriation Medical Centre, University of Melbourne. Source Aust Fam Physician, 1997 Feb, 26:2, 135-43 Abstract Osteoporotic fractures in men are a neglected public health problem. The pathogenesis of bone loss is incompletely understood but is probably due to reduced bone formation rather than increased bone resorption. Primary or secondary hypogonadism is a common and treatable cause of osteoporosis and should be excluded in all men presenting with spine or hip fractures. Alcohol excess, with or without hypogonadism, is a most important attributable risk factor for osteoporosis in men. There is no known treatment for osteoporosis in men (as there have been no clinical trials using anti fracture efficacy as an endpoint in men) and few well designed trials examining the effects of drugs on bone mineral density (BMD). Bisphosphonates, while reducing fracture rates in women, have only been shown to increase BMD in men Calcium supplementation may slow bone loss. Anabolic agents, such as nandrolone have not been adequately studied. Fluoride therapy cannot be recommended as bone strength does not appear to increase despite the well documented increase in BMD. Risk factors such as alcohol excess and tobacco use should be corrected. Language of Publication English Unique Identifier 97198620 tle Comparison of alendronate and sodium fluoride effects on cancellous and cortical bone in minipigs. A one-year study. Author Lafage MH; Balena R; Battle MA; Shea M; Seedor JG; Klein H; Hayes WC; Rodan GA Address Merck Research Laboratories, West Point, Pennsylvania 19486, USA. Source J Clin Invest, 1995 May, 95:5, 2127-33 Abstract Fluoride stimulates trabecular bone formation, whereas bisphosphonates reduce bone resorption and turnover. Fracture prevention has not been convincingly demonstrated for either treatment so far. We compared the effects of 1-yr treatment of 9-mo-old minipigs with sodium fluoride (NaF, 2 mg/kg/d p.o.) or alendronate (ALN, 4 amino-1-hydroxybutylidene bisphosphonate monosodium, 1 mg/kg/d p.o.) on the biomechanical and histomorphometric properties of pig bones. As expected, NaF increased and ALN decreased bone turnover, but in these normal animals neither changed mean bone volume. NaF reduced the strength of cancellous bone from the L4 vertebra, relative to control animals, and the stiffness (resistance to deformation) of the femora, relative to the ALN group... In the ALN-treated animals, there was a strong positive correlation between bone strength and L5 cancellous bone volume, but no such correlation was observed in the NaF group. Furthermore, the modulus (resistance to deformation of the tissue) was inversely related to NaF content and there was a relative decrease in bone strength above 0.25 mg NaF/g bone. Moreover, within the range of changes measured in this study, there was an inverse correlation between bone turnover, estimated as the percentage of osteoid surface, and modulus. These findings have relevant implications regarding the use of these agents for osteoporosis therapy. Language of Publication English Unique Identifier 95256435 Title Effects of sodium fluoride and alendronate on the bone mineral in minipigs: a small-angle X-ray scattering and backscattered electron imaging study. Author Fratzl P; Schreiber S; Roschger P; Lafage MH; Rodan G; Klaushofer K Address Fourth Medical Department, Hanusch Hospital, Vienna, Austria. Source J Bone Miner Res, 1996 Feb, 11:2, 248-53 Abstract Sodium fluoride (NaF), which stimulates bone formation, and bisphosphonates, which reduce bone resorption, are both used in the treatment of osteoporosis, and are binding to bone mineral. In this study, using small-angle X-ray scattering and backscattered electron imaging, we analyzed the bone mineral in the vertebrae of minipigs treated with fluoride, with the bisphosphonate alendronate (ALN), or with vehicle... All specimens were investigated blindly. A slight increase in the average thickness of the mineral crystals as well as changes in the structure of the mineral/collagen composite were found in the case of fluoride-treated animals. No differences were found between ALN-treated animals and controls. The changes produced by fluoride are in the same direction as seen in bones from patients treated with NaF, albeit much smaller. They also correlate quantitatively with the reduction in biomechanical properties of bone in fluoride-treated minipigs found in an earlier study with the same animals. These findings suggest that small changes in the structure of the mineral/collagen composite in bone may considerably affect its biomechanical properties. It also emphasizes the delicate balance between the increase of bone mass and deterioration of bone material properties for the effect of fluoride on the biomechanical properties of bone. Language of Publication English Unique Identifier 96419591 Title Mineralization of cancellous bone after alendronate and sodium fluoride treatment: a quantitative backscattered electron imaging study on minipig ribs. Author Roschger P; Fratzl P; Klaushofer K; Rodan G Address Ludwig Boltzmann-Institute for Osteology, Fourth Medical Department, Hanusch Hospital and Unfallkrankenhaus Meidling, Vienna, Austria. Source Bone, 1997 May, 20:5, 393-7 Abstract Fluoride stimulates bone formation, whereas bisphosphonates reduce bone resorption. In clinical trials, both treatments increase bone density, although sodium fluoride (NaF) increases and alendronate (bisphosphonate, ALN) decreases bone turnover. In a comparative study using minipigs an inverse correlation has been reported between bone turnover and elastic modulus. Small-angle X-ray scattering (SAXS) measurements of these bones revealed no structural deterioration of the collagen/mineral composite at the nanometer range for ALN-treated vertebra, whereas a slight increase of the average thickness of the mineral crystals as well as changes of the structure of the collagen/mineral composite were found in the bones of NaF-treated animals. In this study we used quantitative backscattered electron imaging (qBSE) to investigate the cancellous bones from ribs of minipigs treated with vehicle, NaF, or ALN. This method provides information on the local mineral concentration in the micrometer range. Mineralization spectra were obtained from each treatment group, and statistically significant differences between ALN and controls were found for the peak position, the peak height, the peak width, and the average calcium (Ca) concentration of the mineral distribution. The results reveal that the cancellous bone matrix was more uniformly mineralized after ALN treatment. The reduced bone turnover induced by ALN, documented histomorphometrically could be at the origin of this phenomenon. No significant differences were detected between NaF and control. Together with the earlier SAXS data these results may explain in part the increase in bone density and the improvement of biomechanical properties observed after ALN treatment in animals and in osteoporotic patients. Language of Publication English Unique Identifier 97290589 Title No bones about fluoride. Author Mundy GR Address Department of Medicine/Endocrinology & Metabolism, University of Texas Health Science Center, San Antonio 78284, USA. Source Nat Med, 1995 Nov, 1:11, 1130-1 Abstract We now have a number of effective drugs for osteoporosis. However, close inspection of clinical trials results suggests we should aim for even better ones. Language of Publication English Unique Identifier 96071660 Title Stress fractures of the heads of the metatarsals. A new cause of metatarsal pain. Author Lechevalier D; Fournier B; Leleu T; Crozes P; Magnin J; Eulry F Address Department of Rheumatology, Bégin Armed Forces Instruction Hospital, Saint-Mandé, France. Source Rev Rhum Engl Ed, 1995 Apr, 62:4, 255-9 Abstract We report 16 cases of epiphyseal metatarsal stress fractures in 11 patients. Four patients had osteoporosis and two of these four were under fluoride therapy. Three of the fractures occurred upon resumption of weight-bearing. The fractures were distributed over the five rays; seven fractures were located to the second metatarsal. Manifestations were acute focal metatarsal pain, diffuse edema of the forefoot and inflammatory metatarsophalangeal arthropathy. Delayed, transient visualization of a linear area of epiphyseal sclerosis occurred in 14 cases. Radionuclide bone scans consistently showed early accumulation of the tracer in the metatarsal head. The focus of increased activity extended to the shaft in three cases. The main differential diagnoses are second ray syndrome, metatarsophalangeal arthritis, focal radial reflex sympathetic dystrophy of the foot and osteonecrosis of the metatarsal heads. The clinical and roentgenographic outcome was consistently favorable after one month without weight-bearing. These fractures can simulate, complicate, induce (two cases), reflex sympathetic dystrophy of the foot or occur concomitantly with (two cases).