Open Access Research article

Change of urinary fluoride and bone metabolism indicators in the endemic fluorosis areas of southern china after supplying low fluoride public water

Shaoxian Chen12, Boling Li3, Shao Lin4, Yixiang Huang2, Xinhua Zhao3, Min Zhang3, Yuan Xia3, Xiaoheng Fang3, Junyi Wang3, Syni-An Hwang4 and Shouyi Yu1*

Author affiliations

1 Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, 1813 Guangzhou Dadao North, Guangzhou, Guangdong 510515, People’s Republic of China

2 School of Public Health, Sun Yat-sen University, Zhongshan 2nd Road, Guangzhou 510080, People’s Republic of China

3 School of Public Health, Guangdong Pharmaceutical University, Jianghai Dadao, Guangzhou 510500, People’s Republic of China

4 Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144-3445, USA

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Citation and License

BMC Public Health 2013, 13:156  doi:10.1186/1471-2458-13-156

Published: 20 February 2013



Few studies have evaluated health impacts, especially biomarker changes, following implementation of a new environmental policy. This study examined changes in water fluoride, urinary fluoride (UF), and bone metabolism indicators in children after supplying low fluoride public water in endemic fluorosis areas of Southern China. We also assessed the relationship between UF and serum osteocalcin (BGP), calcitonin (CT), alkaline phosphatase (ALP), and bone mineral density to identify the most sensitive bone metabolism indicators related to fluoride exposure.


Four fluorosis-endemic villages (intervention villages) in Guangdong, China were randomly selected to receive low-fluoride water. One non-endemic fluorosis village with similar socio-economic status, living conditions, and health care access, was selected as the control group. 120 children aged 6-12 years old were randomly chosen from local schools in each village for the study. Water and urinary fluoride content as well as serum BGP, CT, ALP and bone mineral density were measured by the standard methods and compared between the children residing in the intervention villages and the control village. Benchmark dose (BMD) and benchmark dose lower limit (BMDL) were calculated for each bone damage indicator.


Our study found that after water source change, fluoride concentrations in drinking water in all intervention villages (A-D) were significantly reduced to 0.11 mg/l, similar to that in the control village (E). Except for Village A where water change has only been taken place for 6 years, urinary fluoride concentrations in children of the intervention villages were lower or comparable to those in the control village after 10 years of supplying new public water. The values of almost all bone indicators in children living in Villages B-D and ALP in Village A were either lower or similar to those in the control village after the intervention. CT and BGP are sensitive bone metabolism indicators related to UF. While assessing the temporal trend of different abnormal bone indicators after the intervention, bone mineral density showed the most stable and the lowest abnormal rates over time.


Our results suggest that supplying low fluoride public water in Southern China is successful as measured by the reduction of fluoride in water and urine, and changes in various bone indicators to normal levels. A comparison of four bone indicators showed CT and BGP to be the most sensitive indicators.