Fluoride therapy for the vertebral crush fracture syndrome: A status report

FLUORIDE HAS BEEN PROPOSED as a therapy for the vertebral crush fracture syndrome for many years; such proposals have been based largely on the well-characterized syndrome of fluoride intoxication (fluorosis), which is marked by increased skeletal mass and sometimes exuberant bony overgrowths. For various reasons, including the inability to develop a patentable product, the clinical studies necessary to follow this lead and establish efficacy and safety have proceeded slowly. Nevertheless, much information on fluoride use in the treatment of the vertebral crush fracture syndrome has been amassed, and during the past 9 years fluoride therapy has been approved for this use in Austria, Belgium, France, Germany, Luxembourg, The Netherlands, Norway, and Switzerland. This report represents points of concurrence regarding the efficacy and safety of fluoride therapy and considerations relevant to patient management that were developed among conferees at the International Workshop on Fluoride and Bone, Niagara-on-the-Lake, Ontario, Canada, October 12-15, 1988. Involved in this conference were most of the investigators, worldwide, whose work was the basis for the approval of fluoride use in the European nations just listed. Hence, although the conference concentrated mainly on data not previously available, the conferees were also familiar with the evidence on which the earlier approvals had been made. In evaluating the available studies, especially regarding efficacy, the panel convened to articulate a consensus statement that paid particular attention to the criteria respecting quality of evidence developed by the Canadian Task Force on the Periodic Health Examination, 1988, and the United States Preventive Services Task Force, 1988.