ABSTRACT
The question of whether fluoridation contributes to bone disease in patients with renal disease is an important one that deserves attention and further study. The renal clearance of fluoride is directly related to renal function as measured by the creatinine clearance and the ability to excrete fluoride decreases markedly as renal function deteriorates. Ingested fluoride is absorbed mainly in the upper gastrointestinal tract, and trace doses of fluoride leave the blood in minutes, concentrating in bone and kidney. The changes in bone seen in patients with chronic renal insufficiency are complex in that there is a spectrum of findings. Bone biopsy of the iliac crest showed an increase of uncalcified osteoid tissue on bone surfaces, decreased mineral density around osteocytes, low mineralization of cement lines, and much interstitium with an irregular pattern. The available evidence suggests that some patients with long-term renal failure are being affected by drinking water with as little as 2 ppm fluoride.
