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Fluoride has been used for the treatment of osteoporosis since 1961, because it increases trabecular bone mass in the spine and may be effective in the treatment of spinal osteoporosis. Fluoride treatment is still controversial because of its side effects, the high rate of non-responders, possible osteomalacic effect on bone, deleterious effects on cortical bone, and especially because of its uncertain effect on fracture rate. At present, fluoride therapy is highly questionable in the prophylaxis and treatment of osteoporosis.

In a double-blind trial with monofluorophosphate (25 mg fluoride per day) given to 460 aged persons (237 treated, 233 control) for eight months no difference was observed in height, admission to hospital, or mortality. Fractures and exacerbation of arthrosis were more frequent in the fluoride group. Vertebral x-ray films showed no difference. The free ionized fluoride levels in the plasma of the fluoride-treated group were still twice as high two months after treatment ended. Fluoride treatment in the prophylaxis of osteoporosis is not recommended unless there is simultaneous measurement of plasma ionized fluoride levels.

In a double-blind trial, 327 patients (57 men) over 65 (mean age 79.5) years received all possible combinations of calcium carbonate 3 g, vitamin D3 1000 iu, methandienone 2.5 mg and/or placebos daily for 9 months. The higher incidence of bone fractures in the placebo group was not significant. Serum calcium, phosphorus, creatinine, aspartate aminotransferase and alkaline phosphatase were followed: the greatest changes occurred with methandienone, which thus reduced osteoporotic activity and increased the muscular mass most effectively; calcium carbonate had the poorest effect. Surprisingly, coronary mortality was higher among those taking all three active substances. With two treatments the increase was not significant, but when both the groups receiving a combination of any two of the treatments were compared with those taking only one or neither of these two treatments, a significant increase in coronary deaths was seen, most significant (P less than 0.001) in those receiving vitamin D3 and methandienone.