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Is the quality of drinking water a risk factor for self-reported forearm fractures? Cohort of Norway

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Abstract

Summary

Compared to pH ≥7.0 in Norwegian municipal drinking water, pH <7.0 increased the risk of forearm fractures in the population-based Cohort of Norway (CONOR; n = 127,272). The association was attenuated (p > 0.05) after adjustments for indicators of bacteria and organic matter, which may signify an association between poor drinking water and bone health.

Introduction

The Norwegian population has the highest rate of fractures ever reported. A large variation in fracture rate both between and within countries indicates that an environmental factor, such as the quality of drinking water, could be one of the causes of the disparities. Our aim was to investigate a possible association between pH (an important parameter for water quality) and self-reported forearm fracture and to examine whether other water quality factors could account for this association.

Methods

Using Geographic Information Systems, information on the quality of drinking water was linked to CONOR (n = 127,272; mean age, 50.2 ± 15.8 years), a database comprising ten regional epidemiological health surveys from across the country in the time period 1994–2003.

Results

The highest risk of forearm fracture was found at a pH of around 6.75, with a decreasing risk toward both higher and lower pH values. The increased adjusted odds of forearm fracture in men consuming municipal drinking water with pH <7.0 compared to water with pH ≥7.0 was odds ratio (OR) = 1.19 (95 % CI, 1.14, 1.25), and the corresponding increased odds in women was OR = 1.14 (95 % CI, 1.08, 1.19). This association was attenuated (p > 0.05) after further adjustments for other water quality factors (color grade, intestinal enterococci, and Clostridium perfringens).

Conclusions

Our findings indicate a higher risk of fracture when consuming water of an acidic pH; however, the risk does not only seem to be due to the acidity level per se, but also to other aspects of water quality associated with pH.

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Acknowledgments

This study was supported by grants from the Norwegian Research Council. The authors wish to acknowledge the services of Cohort of Norway (CONOR), the contributing research centers delivering data to CONOR, and all the study participants. Carl Fredrik Nordheim and Liliane Myrstad (Norwegian Waterworks Register) have contributed greatly in the collection and validation of data on water quality.

Conflicts of interest

Professor Tell did not report receiving fees, honoraria, grants, or consultancies. The Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway is, however, involved in studies with funding from a pharmaceutical company as a research grant to (and administered by) the university. This study has no relation to the present study. All other authors declare that they do not have any financial conflicts of interest. In addition, all authors report that they did not have any limitations on access to data or other materials critical to the work being reported.

Author information

Authors and Affiliations

  1. Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway

    C. Dahl, A. J. Søgaard & G. Aamodt

  2. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

    C. Dahl & G. S. Tell

  3. Department of Chemistry, Norwegian University of Science and Technology, Trondheim, Norway

    T. P. Flaten

  4. Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway

    T. Krogh

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  1. C. Dahl
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On behalf of the NOREPOS Core Research Group

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Correspondence to C. Dahl.

Additional information

The members of the NOREPOS Core Research Group are Nina Emaus, Guri Grimnes (Tromsø), Haakon E. Meyer, Anne Johanne Søgaard (Oslo), Berit Schei, Siri Forsmo (Nord-Trøndelag), Grethe S. Tell, and Clara Gram Gjesdal (Bergen).

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Dahl, C., Søgaard, A.J., Tell, G.S. et al. Is the quality of drinking water a risk factor for self-reported forearm fractures? Cohort of Norway. Osteoporos Int 24, 541–551 (2013). https://doi.org/10.1007/s00198-012-1989-7

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