Abstract
The aim of this study was to examine the association between fluoride exposure and bone mineral density (BMD) in children and adolescents. We used data from the National Health and Nutrition Examination Survey (NHANES) 2015-2016. The fluoride concentrations in the water samples, plasma samples, and urine samples were measured electrometrically using an ion-specific electrode. Total body less head BMD (TBLH BMD) was measured using dual-energy X-ray absorptiometry (DXA). Weighted generalized linear regression models and restricted cubic splines (RCS) regression models were used to analyze the relationships between the three types of fluoride exposure and TBLH BMD. We performed subgroup analyses stratified by sex. A total of 1413 US children and adolescents were included in our study. In our linear regression models, we found inverse associations between fluoride concentrations in water and plasma and TBLH BMD. Additionally, we discovered a non-linear association between fluoride concentrations in water and plasma and TBLH BMD. No significant association or non-linear relationship was found between urine fluoride levels and TBLH BMD. This nationally representative sample study provides valuable insight into the intricate connection between fluoride exposure and skeletal health in children and adolescents.