BMJ 2001;322:1486 ( 16 June )

Letters

Water fluoridation

    Meta-analysis of fluoridation and fractures has been done
    Critical difference was overlooked
    Clearer evidence of benefits and risks is needed
    Government should meet commitment made in white paper
    Authors' reply
    Results should be viewed with concern rather than applause
    Authors' reply
    Little is known about the safety of fluoridation
    Ireland has less decay in non-fluoridated communities

Meta-analysis of fluoridation and fractures has been done

The first 150 words of the full text of this article appear below.

EDITOR---The article by McDonagh et al is valuable but not necessarily new in the area of fractures.1 They conclude that the evidence relating fluoridation to fractures is weak and shows no significant effect either way. This is identical to the conclusion that we published in a 1999 meta-analysis not cited by McDonagh et al but listed on Medline.2 This study located 26 studies in this area, compared with their 20, and reported a relative risk for fracture of 1.02 (95% confidence interval 0.96 to 1.09). Interestingly, sex, urbanicity index, and the quality (but not duration) of the study explained 25% of the variation between studies in meta-regression.

Further work in this area will need to be done at an individual level to advance this field, but even this is problematic given the paper by Phipps et al in the same issue of the journal, which reports on a very large cohort of women.3 . . . [Full text of this article]
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