Osteoporosis International

, Volume 24, Issue 2, pp 541–551 | Cite as

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

  • C. Dahl
  • A. J. Søgaard
  • G. S. Tell
  • T. P. Flaten
  • T. Krogh
  • G. Aamodt
  • On behalf of the NOREPOS Core Research Group
Original Article

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.

Keywords

Epidemiology Forearm fracture pH Water microbiology Water supply 

Supplementary material

198_2012_1989_MOESM1_ESM.pdf (229 kb)
ESM 1(PDF 228 kb)

References

  1. 1.
    Ismail AA, Pye SR, Cockerill WC, Lunt M et al (2002) Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 13:565–571PubMedCrossRefGoogle Scholar
  2. 2.
    Lofthus CM, Frihagen F, Meyer HE, Nordsletten L, Melhuus K, Falch JA (2008) Epidemiology of distal forearm fractures in Oslo, Norway. Osteoporos Int 19:781–786PubMedCrossRefGoogle Scholar
  3. 3.
    Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386PubMedCrossRefGoogle Scholar
  4. 4.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  5. 5.
    Omsland TK, Ahmed LA, Gronskag A, Schei B, Emaus N, Langhammer A, Joakimsen RM, Jorgensen L, Sogaard AJ, Gjesdal CG, Meyer HE (2011) More forearm fractures among urban than rural women: the NOREPOS study based on the Tromso study and the HUNT study. J Bone Miner Res 26:850–856PubMedCrossRefGoogle Scholar
  6. 6.
    Sanders KM, Nicholson GC, Ugoni AM, Seeman E, Pasco JA, Kotowicz MA (2002) Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study. J Epidemiol Community Health 56:466–470PubMedCrossRefGoogle Scholar
  7. 7.
    Søgaard AJ, Gustad TK, Bjertness E, Tell GS, Schei B, Emaus N, Meyer HE (2007) Urban–rural differences in distal forearm fractures: Cohort Norway. Osteoporos Int 18:1063–1072PubMedCrossRefGoogle Scholar
  8. 8.
    Flaten TP (2004) An investigation of the chemical composition of Norwegian drinking water and its possible relationships with the epidemiology of some diseases. Dissertation, Norwegian University of Science and TechnologyGoogle Scholar
  9. 9.
    Flaten TP (1991) A nation-wide survey of the chemical composition of drinking water in Norway. Sci Total Environ 102:35–73PubMedCrossRefGoogle Scholar
  10. 10.
    Norwegian Institute of Public Health (2004) [Watersupply ABC: chapter C, watersources and catchment]. Drinking water quality and hygiene [in Norwegian]. Available at http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=5631:0:15,3030:1:0:0:::0:0. Accessed 5 May 2011
  11. 11.
    Norwegian Institute of Public Health (2006) [Watersupply ABC: chapter E, water distribution system]. Drinking water quality and hygiene [in Norwegian]. Available at http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=5631:0:15,3030:1:0:0:::0:0. Accessed 13 May 2011
  12. 12.
    Norwegian Institute of Public Health (2008) [Watersupply ABC: chapter D, water treatment]. Drinking water quality and hygiene [in Norwegian]. Available at http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=5631:0:15,3030:1:0:0:::0:0. Accessed 13 May 2011
  13. 13.
    Tomten SE, Hoestmark AT (2003) Acid and bone resorption. In: Bjertness E (ed) Osteoporosis: from mechanisms and risk factors to prevention, geographical differences in a country with the highest incidence rates of hip fractures in the world. The Norwegian Academy of Science and Letters, Oslo, pp 35–42Google Scholar
  14. 14.
    Rylander R (2008) Drinking water constituents and disease. J Nutr 138:423S–425SPubMedGoogle Scholar
  15. 15.
    Krapf R, Seldin DW, Alpern RJ (2000) Clinical syndromes of metabolic acidosis. In: Seldin DW, Giebisch G (eds) The kidney, physiology and pathophysiology, 3rd edn. Lippincott Williams and Wilkins, Philadelphia, pp 2073–2130Google Scholar
  16. 16.
    Frings-Meuthen P, Baecker N, Heer M (2008) Low-grade metabolic acidosis may be the cause of sodium chloride-induced exaggerated bone resorption. J Bone Miner Res 23:517–524PubMedCrossRefGoogle Scholar
  17. 17.
    World Health Organization (2004) Guidelines for drinking-water quality, vol 1, 3rd edn. World Health Organization, GenevaGoogle Scholar
  18. 18.
    Frengstad B, Banks D, Siewers U (2001) The chemistry of Norwegian groundwaters: IV. The pH-dependence of element concentrations in crystalline bedrock groundwaters. Sci Total Environ 277:101–117PubMedCrossRefGoogle Scholar
  19. 19.
    Nordberg GF, Goyer RA, Clarkson TW (1985) Impact of effects of acid precipitation on toxicity of metals. Environ Health Perspect 63:169–180PubMedCrossRefGoogle Scholar
  20. 20.
    Prescott LM, Harley JP, Klein DA (2002) Microbial growth. In: Microbiology, 5th edn. McGraw-Hill, New York, pp 123–125Google Scholar
  21. 21.
    Ministry of health and care services (2011) [Regulations on water supply and drinking water], Norwegian Law Gazette [in Norwegian]. Available at http://www.lovdata.no/cgi-wift/ldles?doc=/sf/sf/sf-20011204-1372.html, Accessed 11 April 2011
  22. 22.
    Norwegian Institute of Public Health (2004) [Watersupply ABC: chapter B, water quality]. Drinking water quality and hygiene [in Norwegian]. Available at http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=5631:0:15,3030:1:0:0:::0:0. Accessed 29 April 2011
  23. 23.
    Naess O, Sogaard AJ, Arnesen E, Beckstrom AC, Bjertness E, Engeland A, Hjort PF, Holmen J, Magnus P, Njolstad I, Tell GS, Vatten L, Vollset SE, Aamodt G (2008) Cohort profile: cohort of Norway (CONOR). Int J Epidemiol 37:481–485PubMedCrossRefGoogle Scholar
  24. 24.
    Norwegian Institute of Public Health (2011) [Waterworks register]. Drinking water quality and hygiene [in Norwegian]. Available at http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=5631:0:15,2873:1:0:0:::0:0. Accessed 24 March 2011
  25. 25.
    Cressie NAC (1993) Statistics for spatial data, revth edn. John Wiley & Sons INC, New YorkGoogle Scholar
  26. 26.
    Krieger NS, Frick KK, Bushinsky DA (2004) Mechanism of acid-induced bone resorption. Curr Opin Nephrol Hypertens 13:423–436PubMedCrossRefGoogle Scholar
  27. 27.
    Wynn E, Krieg MA, Aeschlimann JM, Burckhardt P (2009) Alkaline mineral water lowers bone resorption even in calcium sufficiency: alkaline mineral water and bone metabolism. Bone 44:120–124PubMedCrossRefGoogle Scholar
  28. 28.
    Rylander R, Remer T, Berkemeyer S, Vormann J (2006) Acid–base status affects renal magnesium losses in healthy, elderly persons. J Nutr 136:2374–2377PubMedGoogle Scholar
  29. 29.
    Heaney RP, Rafferty K (2001) Carbonated beverages and urinary calcium excretion. Am J Clin Nutr 74:343–347PubMedGoogle Scholar
  30. 30.
    Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP (2006) Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: the Framingham Osteoporosis Study. Am J Clin Nutr 84:936–942PubMedGoogle Scholar
  31. 31.
    Bernstein CN, Leslie WD (2004) Osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther 19:941–952PubMedCrossRefGoogle Scholar
  32. 32.
    Henderson B, Nair SP (2003) Hard labour: bacterial infection of the skeleton. Trends Microbiol 11:570–577PubMedCrossRefGoogle Scholar
  33. 33.
    Amcheslavsky A, Hemmi H, Akira S, Bar-Shavit Z (2005) Differential contribution of osteoclast- and osteoblast-lineage cells to CpG-oligodeoxynucleotide (CpG-ODN) modulation of osteoclastogenesis. J Bone Miner Res 20:1692–1699PubMedCrossRefGoogle Scholar
  34. 34.
    Ciampolini J, Harding KG (2000) Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often? Postgrad Med J 76:479–483PubMedCrossRefGoogle Scholar
  35. 35.
    Mjoberg B, Hellquist E, Mallmin H, Lindh U (1997) Aluminum, Alzheimer's disease and bone fragility. Acta Orthop Scand 68:511–514PubMedCrossRefGoogle Scholar
  36. 36.
    Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ, Lewis CE, Kipersztok S, Borne C, Jackson RD (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women’s Health Initiative observational study and clinical trials. Menopause 11:264–274PubMedCrossRefGoogle Scholar
  37. 37.
    Ismail AA, O’Neill TW, Cockerill W et al (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European Prospective Osteoporosis Study Group. Osteoporos Int 11:248–254PubMedCrossRefGoogle Scholar
  38. 38.
    Nevitt MC, Cummings SR, Browner WS et al (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135:490–499PubMedGoogle Scholar
  39. 39.
    Joakimsen RM, Fonnebo V, Sogaard AJ, Tollan A, Stormer J, Magnus JH (2001) The Tromso study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register? Osteoporos Int 12:1001–1005PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • C. Dahl
    • 1
    • 2
  • A. J. Søgaard
    • 1
  • G. S. Tell
    • 2
  • T. P. Flaten
    • 3
  • T. Krogh
    • 4
  • G. Aamodt
    • 1
  • On behalf of the NOREPOS Core Research Group
  1. 1.Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway
  2. 2.Department of Public Health and Primary Health CareUniversity of BergenBergenNorway
  3. 3.Department of ChemistryNorwegian University of Science and TechnologyTrondheimNorway
  4. 4.Division of Environmental MedicineNorwegian Institute of Public HealthOsloNorway

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