CRD Summary: The review concluded that treatment with fluoride increased spine and hip bone mass density. A low fluoride dose (20 mg per day or less of fluoride equivalents) was associated with a significant reduction in fracture risk. Given several limitations of the review the authors’ conclusions should be treated with caution.

[The primary studies evaluated a variety of different formulations of fluoride (including sodium fluoride, slow release fluoride and monofluorophosphate) different doses of fluoride (≤20 mg and >20 mg) and combinations of treatments (regimens included hormone replacement therapy, etidronate, calcium and vitamin D). ]

CRD Commentary: Inclusion criteria were specified for study design and outcomes. Criteria for intervention were somewhat broad since combinations of various treatments were permitted and no criteria were defined for participants. Some relevant sources were searched, but no attempts were made to minimise language bias. No attempts were made to locate unpublished studies, but appropriate methods were used to assess publication bias and no evidence of its presence was found. Methods used to select studies, assess validity and extract data were not described, so it was unknown whether efforts were made to reduce reviewer errors and bias. Validity was assessed using an established checklist, although only the composite score was presented making it difficult to judge study validity. Combining the studies in a meta-analysis may not have been appropriate due to the considerable differences between studies. The authors concluded that treatment with fluoride increased spine and hip BMD, dependent on treatment duration. Given the identified weaknesses of the review the authors’ conclusions should be treated with caution.