Question to the Department of Health and Social Care:

To ask Her Majesty’s Government, in the light of the statement in the Executive Summary of the <i>Water fluoridation: Health monitoring report for England 2014</i> that there is "no evidence of a difference in the rate of hip fractures between fluoridated and non-fluoridated areas", what account Public Health England took of the article "Adding fluoride to water supplies" by Cheng KK et al in the <i>British Medical Journal</i> of 7 October 2007, in which the authors state that if the population of England had an average lifetime exposure of ≥0.9 ppm fluoride in drinking water a modest association between fluoride and hip fracture, if such exists, would have a less than one in five chance of being detected despite potentially causing more than 10,000 excess fractures a year.

The possible effects of fluoride in water have been extensively studied and reviewed over the last 50 years. In the United Kingdom the most recent review prior to the publication of Public Health England’s (PHE) Health Monitoring Report was undertaken by the National Health Service Centre for Reviews and Dissemination based at the University of York and published in 2000. The Medical Research Council subsequently, in 2002, reported to the Department of Health its advice on future research priorities. The US National Research Council reported in 2006 and the Australian National Health and Medical Research Council reported in 2007. PHE drew on these authoritative sources in selecting a number of indicators of health conditions for inclusion in the 2014 water fluoridation health monitoring report.

The chosen indicators of various health conditions were selected based on the evidence base, theoretical plausibility, potential impact on population health, the quality and availability of data, and the validity of the indicator. The selected indicators will be reviewed for future reports in the light of emerging evidence.

The article by KK Cheng et al did not provide any new evidence regarding hip fractures, but comments on the chance of detecting an increased risk of hip fracture for a speculated odds ratio of 1.2 in a previous study by Hiller et al. 2000. This only refers to a single study and it is important to consider the overall weight of evidence.

The overall weight of evidence and the consensus of opinion from authoritative reviews do not indicate that a drinking water concentration of 1 part fluoride per million parts of water presents an increased risk of hip fracture.

A more recent review of potential health effects from water fluoridation was published in 2015 by the Irish Research Board. The report concluded that a summary of the existing literature indicates that the relationship between fluoride in drinking water and bone health is inconsistent, with no definitive proof of protective or harmful effects.