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Conclusion <br /> There does not appear to be strong evidence for an association between higher rates of <br /> hypothyroidism and drinking water with fluoride levels < 0.7 ppm. In future research, it would <br /> be important to control for family history of hypothyroidism. <br /> • Fluoride increases incidence of certain cancers <br /> o Cancer (overall) risk - Fluoride is not listed as a chemical known to cause cancer or <br /> reproductive toxicity by the State of California's Office of Environmental Health Hazard <br /> Assessment of the California Environmental Protection Agency (Proposition 6510) <br /> • Fluoride makes bones brittle <br /> o Fracture risk- A meta-analysis of observational studies by Yin et all, found no increased <br /> fracture risk with fluoridated drinking water. The authors note that many studies did not <br /> control for potential confounders and had possible exposure misclassification. Large scale <br /> studies are needed. <br /> • Fluoride concentrates in the spines causing backaches. <br /> o Musculoskeletal Pain - The CADTH' review addresses the question of increased <br /> musculoskeletal pain with higher levels of fluoride exposure. A cross sectional study in <br /> Thailand found an increased risk of low back pain being reported with fluoridated community <br /> water containing greater than 0.7 ppm compared to less than 0.7 ppm. An ecologic study in <br /> India found that study subjects had increased reported joint pain at >1.5 ppm fluoride in <br /> drinking water, but less joint pain reported in subjects with exposure to water containing 0.4- <br /> 1.5 ppm fluoride than in subjects with exposure to water with less than 0.4 ppm fluoride. The <br /> review authors note concern about inadequate control for confounding variables studies. <br /> Skeletal fluorosis is known to be a risk of chronic, high level exposure to fluoride. An <br /> 20 <br />