Introduction/Objective: We conducted a Cochrane systematic review to determine the efficacy of fluoride therapy at preventing bone loss and fractures in postmenopausal women.

Methods: A literature search was conducted in MEDLINE, Current Contents and the Cochrane Controlled Trials Registry up to January 1998 according to the methods suggested by Haynes et al. Two independent reviewers selected randomized controlled trials (RCTs) which met predetermined inclusion criteria. These two reviewers independently extracted data using predetermined forms and assessed trial quality using Jadad's scale. Statistical analysis: For dichotomous outcomes, relative risks were calculated and for continuous data, weighted mean differences (WMD) of the percentage change from baseline were calculated. Where heterogeneity existed (determined by a Chi square test), random effects models were used.

Results: Eleven RCTs met the inclusion criteria. After two years of fluoride treatment, lumbar BMD was significantly increased, WMD: 7.7 (95% Cl: 5.7-9.8), relative to placebo. Vertebral fractures were no different between placebo and fluoride (RR: 0.99, 95%CI: 0.8-1.3). Gastrointestinal (Gl) side-effects were statistically significant for high dose fluoride compared to placebo (RR: 2.3, 95%CI: 1.3-4.2). Non-vertebral fractures were statistically increased with high dose fluoride (RR: 2.3, 95%CI: 1.6-3.3) but not low dose fluoride (RR: 1.1, 95%CI: 0.7-1.7) compared to placebo.

Discussion: Although fluoride has an ability to stimulate increases in bone mineral density, it does not reduce vertebral fracture rates. Also, high dose fluoride has significant Gl side effects and increases non-vertebral fracture rates. Given these drawbacks of fluoride, it is not a clinically useful therapy for postmenopausal osteoporosis.