The associations between plasma fluoride and bone mass in children and adolescents

Background: Peak bone mass is attained during childhood and adolescence and is a key determinant of osteoporosis risk later in life. This study investigated the associations between plasma fluoride levels and bone mineral density (BMD) and bone mineral content (BMC) in children and adolescents. Methods: We analyzed data from 2851 children and adolescents (8–18 years), collected through the National Health and Nutrition Examination Survey 2013–2016. We performed multivariable linear regression analyses to examine the relationships between plasma fluoride levels and bone mass, adjusting for sociodemographic factors, calcium and vitamin D intake, and physical activity. Results: Plasma fluoride levels among children and adolescents aged 8–18 were not significantly associated with BMD or BMC, except in girls aged 12–18. In this group, higher fluoride levels were associated with higher BMD in the total body (B = 0.025, P = 0.031) and legs (B = 0.031, P = 0.037). However, no association was found between plasma fluoride levels and BMC in girls aged 12–18. Conclusion: Higher fluoride levels were statistically significantly associated with higher BMD in girls aged 12–18. However, in other age groups and sexes, fluoride levels were not significantly associated with BMD or BMC levels. Impact: Except for girls aged 12–18, plasma fluoride levels among children and adolescents aged 8–18 were not statistically significantly associated with bone mineral density (BMD) or bone mineral content (BMC). Higher fluoride levels in girls aged 12–18 were associated with higher BMD in the total body and legs. Our findings indicated that higher fluoride exposure may not be associated with lower BMD or BMC. Further investigation is warranted to clarify the effects of fluoride exposure on bone health and the underlying mechanisms in young populations.