Osteoporosis fluoride

Calcitonin therapy results in decreased bone resorption. Osteoclasts have calcitonin receptors and calcitonin inhibits their activity. Sodium fluoride stimulates bone formation by unknown mechanisms. In women with osteoporosis, fluoride therapy produced an increased bone mineral density but no reduction in the rate of vertebral fractures. Other drugs known as selective estrogen receptor modulators (raloxifene, droloxifene, idoxifene, and levormeloxifene) may provide an alternative to estrogen replacement therapy (Chapter 34). Administration of low doses of PTH [or recombinant PTH( 1 -34)] does not affect serum calcium concentration, promotes bone formation, and increases mineral density. This anabolic action of PTH is probably mediated by decreasing osteoblast apoptosis. 

Fluoride stimulates bone formation by protein kinase activation mediated effects on osteoblasts. Fluorides have been used in the treatment of osteoporosis, but their anti-fracture effect is not undisputed. 

Other indoles that have been prepared using the Sonogashira coupling and cyclization sequence include 5,7-difluoroindole and 5,6,7-trifluoroindole [219], 4-, 5-, and 7-methoxyindoles and 5-, 6-, and 7-(triisopropylsilyl)oxyindoles [220], the 5,6-dichloroindole SB 242784, a compound in development for the treatment of osteoporosis [221], 5-azaindoles [222], 7-azaindoles [160], 2,2-biindolyls [223,176], 2-octylindole for use in a synthesis of carazostatin [224], chiral indole precursors for syntheses of carbazoquinocins A and D [225], a series of 5,7-disubstituted indoles [226], a pyrrolo[2,3-eJindole [226], an indolo[7,6-g]indole [227], pyrrolo[3,2,l-y]quinolines from 4-arylamino-8-iodoquinolines [228], optically active indol-2-ylarylcarbinols [229], 2-alkynylindoles [176], 7-substituted indoles via the lithiation of the intermediate 2-alkynylaniline derivative [230], and a variety of 2,5,6-trisubstituted indoles [231], This latter study employs tetrabutylammonium fluoride, instead of Cul or alkoxide, to effect the final cyclization of 215 to indoles 216 as summarized here. 

Based on limited epidemiologic evidence, fluoride supplements, with or without calcium, estrogen and vitamin D, are used by clinicians for the treatment of osteoporosis. However, knowledge of the effects of fluoride on calcium and phosphorus metabolism in normal animals is limited although Spencer et al. (32) reported that ingestion of fluoride by three osteoporotic men did not affect calcium absorption but caused a decrease in urinary excretion. Moreover, there is a need to determine the long-term effects of fluoride treatment on bone strength and on soft tissues ( ). 

In summary, the results of this life-long experiment on female mice indicated that low or high Ca intake early in life did not have any significant effect on the skeletal Ca in adulthood, but the continued high Ca intake reduced the turnover rate in old age. Consequently the strengh of the bone was better preserved than that in the mice fed the low Ca diet. This supports the use of Ca supplements even in old patients suffering from osteoporosis, provided their vitamin D status is adequate. Dietary fluoride... 

Fluoride, Fluoride Is contained In water and In the diet (22,23) Also, fluoride stabilizes the bone crystal (24) and has been shown to decrease bone resorption (25), For these reasons, fluoride has been recommended for the treatment for osteoporosis (26-28), The Importance of the role of fluoride on maintaining the normal bone structure Is also Indicated by a survey which showed that the Incidence of osteoporosis was lower In naturally high fluoride areas than In areas where the fluoride content of the drinking water was low (29) This observation would Indicate that the Intake of certain amounts of fluoride throughout life may be necessary for the maintenance of the normal skeleton, and that fluoride may protect the skeleton from the development of bone loss which leads to osteoporosis with advancing age, particularly In females. 

In extensive studies of the effect of fluoride In patients with osteoporosis carried out In this Research Unit, a therapeutic dally dose of 45 mg fluoride per day was used as sodium fluoride. The main effect of fluoride on calcium metabolism was a decrease of the urinary calcium, while the fecal calcium did not change and the calcium balance also remained unchanged. Also, the Intestinal absorption of calcium remained unchanged during the high fluoride Intake (Table I), The decrease In urinary calcium, Induced by sodium fluoride, may be due to decreased bone resorption, a very desirable effect for patients with osteoporosis. 

Alternatives to steroid hormone therapy for osteoporosis include raloxifene, bisphosphonates, sodium fluoride, vitamin D and calcium supplementation, calcitonin, and parathyroid hormone. Tamoxifen has estrogenic effects on bone and delays bone loss in postmenopausal women. However as a result of estrogenic activity in the uterus, long-term tamoxifen administration has been associated with an increased risk of... 

M. Kleerekoper, D.B. Mendlovic, Sodium fluoride therapy of postmenopausal osteoporosis, Endocr. Rev. 14 (1993) 312-323. 

L.L. Demos, H. Kazda, F.M. Cicuttini, M.l. Sinclair, C.K. Fairley, Water fluoridation, osteoporosis, fractures—Recent developments, Aust. Dent. J. 46 (2001) 80-87. 

C.Y.C. Pak, K. Sakheee, B. Adams-Huet, V. Piziak, R.D. Peterson, J.R. Poindexter, Treatment of postmenopausal osteoporosis with slow-release sodium fluoride Final report of a randomized controlled trial, Ann. Intern. Med. 123 (1995) 401-408. 

P.J. Meurnier, J-L. Sebert, J.Y. Reginster, D. Briancon, T. Appelboom, P. Netter, G. Loeb, A. Rouillon, S. Barry, J.C. Evereux, B. Avouac, X. Marchandise, Fluoride salts are no better at preventing new vertebral fractures than calcium-vitamin D in postmenopausal osteoporosis. The FAVO study, Osteoporos. Int. 8 (1998) 4-12. 

A conflict arises from two claims the first, that fluoride stimulates new bone growth and hence is useful therapeutically in controlling osteoporosis, and the other, that it is the cause of the increasing prevalence of hip fractures in the elderly [6]. Fluoride is currently not recommended for the treatment of osteoporosis, although slow release fluoride therapy is reportedly beneficial. The long-term benefit of the latter is unknown [7]. 

This paper is written with the aim of providing sufficient background to help understand the mechanism of action of fluoride ion on humans. The main focus is on the effects of fluoride on dental health, in-depth discussion of skeletal fluorosis and use of fluoride for treating osteoporosis being outside the scope of this paper. Current information on the main sources of human exposure to fluoride and current recommendations for adequate intake (Al) of fluoride, as well as methods for assessing exposure, will be reviewed. 

Fluoride is well established as effective for the prophylaxis of dental caries and has been under investigation for the treatment of osteoporosis. Both therapeutic applications originated from epidemiologic observations that subjects living in areas with naturally fluoridated water (1-2 ppm) had less dental caries and fewer vertebral compression fractures than subjects living in nonfluoridated water areas. Fluoride is accumulated by bones and teeth, where it may stabilize the... 

Despite early promise that fluoride might be useful in the prevention or treatment of postmenopausal osteoporosis, this form of therapy remains controversial. A new formulation of fluoride (slow release, lower dose) appears to avoid much of the toxicity of earlier formulations and may reduce fracture rates. However, this formulation has not been approved by the FDA. 

Teriparatide, the recombinant form of PTH 1-34, is approved for treatment of osteoporosis. Teriparatide is given in a dosage of 20 meg subcutaneously daily. Like fluoride, teriparatide stimulates new bone formation, but unlike fluoride, this new bone appears structurally normal and is associated with a substantial reduction in the incidence of fractures. Teriparatide is approved for use for only 2 years. Trials examining the sequential use of teriparatide followed by a bisphosphonate after 1 or 2 years are in progress and look promising. Giving teriparatide with a bisphosphonate has not shown greater efficacy than the bisphosphonate alone. 

Fluorine Probably essential element used as CaFj by some mob hisks. Moderately toxic, msy cause mottled teeth. Pollution by fluoride present in superphosphate fertilizers. Ca. 1 ppm In water provides cariostatic action, beneficial in the treatment of Osteoporosis. 

Fluorine 3 g 1.5-4 mg Structure of teeth, bones Dental caries, possibly osteoporosis Dental fluorides severe fluorosis in parts of India and South Africa... 

Calcium, phosphorus and vitamin D are needed for formation of bones and teeth. Supplements containing calcium, fluoride and vitamin D are commonly used to treat osteoporosis, and some American physicians recommend Turns as an inexpensive source of calcium. Calcium is needed also for formation of milk, maintaining correct heart rhythm, and conversion of fibrinogen into fibrin to form blood clots. Calcium salts are sometimes administered to promote blood clotting. 

Fluoride is a potent stimulator of trabecular bone formation. Sodium monofluorophosphate was given to 48 patients with osteoporosis due to glucocorticoids (more than 10 mg of prednisone equivalents/day). Patients were randomly allocated to 1 g of calcium carbonate (control) or 200 mg of sodium monofluorophosphate plus 1 g of... 

There is a great deal of both popular and professional interest in the etiology, diagnosis, prevention, and treatment of osteoporosis. The extent of this disease in the United States is a major public health concern. No single cause can be identified. Certainly the influence of hormones, dietary intakes of Ca, fluoride and vitamin D are significant. Our results suggest that it may be prudent to consider the possibility that trace element deficiencies, particularly of Mn, may be of significance. 

Glucocorticoid treatment for arthritis or other ailments can very quickly produce a form of osteoporosis caused by the inhibition of bone formation [334]. In such cases, the decrease in bone mass may be as much as 10-20%, but examination of trabecular bone reveals a much greater (30-40%) decrease in this component of bone [335]. Combination therapies with vitamin D and bisphosphonates, calcitonin or fluoride can be effective [336]. Therapy employing vitamin D or 1,25-(OH)2D3, the latter being highly calcaemic, should also include serum calcium monitoring and the use of thiazide diuretics as appropriate. 

Antiarrhythmic drugs after myocardial infarction Fluoride treatment for osteoporosis Bedrest in twin pregnancy... 

Riggs BL, Hodgson SF, O Fallon WM et al. (1990). fiffect of fluoride treatment on fracture rate in postmenopausal women with osteoporosis. New England Journal of Medicine 322 802-809... 

Fluorine is widely distributed in Nature, representing about 0.065% of the earth s crust, making it the 13th most abundant element. It is more abundant than chlorine and much more abundant than common metals such as zinc and copper. Fluorine occurs in many minerals in which fluoride ion replaces hydroxide. The conversion of hydroxyapatite to flu-oroapatite strengthens tooth enamel. However, this would result in an increased brittleness in bones. An untested theory is that the widespread use of fluoride in drinking water, which had remarkable benefits in preventing dental caries in the 1960s, may be the cause of the rise in osteoporosis in the elderly population. 

Pollution by fluoride present in superjiiosphate fertilizers. Ca. I ppm in water provides cariostatlc aclion/ beneficial in the treatment Osteoporosis. 

---