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- Discussion:
    - stimulates osteoblasts directly;
    - in dosages of 40-80 mg per day, Na fluoride can increase trabecular-bone density of the axial skeleton substantially but does not increase cortical-bone density in the appendicular skeleton;
    - concurrent calcium administration prevents or minimizes the mineralization defect that may occur when fluoride is given alone;
    - fluorotic bone may be less strong than equivalent amount of normal bone;
    - substantial increases of trabecular-bone mass after therapy w/ fluoride plus Ca increases net bone strength & reduces occurrence of new fractures by > 50 %;
           - when this therapy is combined with estrogen, new fractures are reduced by 94 %;

- Side Effects:
    - about 30 % of treated pts have symptoms of gastric irritation, & about 10 % have an acute lower-extremity pain syndrome;
    - latter may be due to increased bone remodeling in weight-bearing bones and may be associated with stress microfractures