Abstract
Acute pain in the lower extremity, which has previously been attributed to synovitis or fasciitis, develops in about 15 percent of osteoporotic patients treated with sodium fluoride. This report describes 11 osteoporotic women in whom this syndrome developed while they were being treated with sodium fluoride (mean dose 78 mg per day; range, 60 to 90). [99mTc]Hydroxymethylene diphosphonate scintiscanning showed an increased number of foci of abnormal uptake in the lower extremities (p less than 0.05), when compared with results of scintiscanning in 12 nonsymptomatic osteoporotic women treated with sodium fluoride and 12 osteoporotic women treated with oral calcium carbonate only. The increased uptake was not restricted to the areas of pain. Roentgenography revealed stress microfractures in five of the 11 symptomatic patients. It is concluded that the acute lower extremity pain syndrome during fluoride therapy usually results from intense regional bone remodeling, which may be complicated by stress microfractures.
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Bone mineral structure after six years fluoride treatment investigated by backscattered electron imaging (BSEI) and small angle x-ray scattering (SAXS): a case report
NaF, a bone formation stimulating agent, is used for the treatment of osteoporosis. Controversy exists concerning the quality of the newly formed bone and the antifracture effectiveness. We report about a 70 years old woman, who had received 50 mg NaF/d for about 6 years. Calcium or Vit D supplements
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Bone resorption and quantitative ultrasound in an endemic fluorosis area of Turkey.
The purpose of this prospective study was to investigate the quantity and quality of bone by quantitative ultrasound (QUS) measurements and to assess bone resorption by urinary excretion measurement of C-terminal telopeptide of type I collagen (CTX) in an adult Turkish population living in an endemic fluorosis area and consuming
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Exposure to natural fluoride in well water and hip fracture: a cohort analysis in Finland
In the retrospective cohort study based on record linkage, the authors studied a cohort of persons born in 1900-1930 (n = 144,627), who had lived in the same rural location at least from 1967 to 1980. Estimates for fluoride concentrations (median, 0.1 mg/liter; maximum, 2.4 mg/liter) in well water in
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Marked decrease in trabecular bone quality after five years of sodium fluoride therapy--assessed by biomechanical testing of iliac crest bone biopsies in osteoporotic patients
Sodium fluoride has for more than 2 decades been a commonly used therapeutic agent for established osteoporosis because of a repeatedly documented anabolic effect on trabecular bone mass. Recently, however, three controlled trials have failed to demonstrate any therapeutic advantage of NaF over placebo with respect to vertebral fracture rate.
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Long-term fluoride therapy of postmenopausal osteoporosis
The benefit of sodium fluoride (NaF) in the therapy of osteoporosis is still controversial. For 3 years we monitored patients with postmenopausal osteoporosis subjected to a continuous treatment with 80 mg NaF/day and patients without fluoride treatment. Every 3 months peripheral total and trabecular bone densities were evaluated with high-precision
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Fluoride Reduces Bone Strength Prior to Onset of Skeletal Fluorosis
The majority of animal studies investigating fluoride's impact on bone strength have found that fluoride has either no effect, or a detrimental effect, on bone strength. Importantly, several of the animal studies that have found fluoride reductes bone strength have reported that this reduction in strength occurs before signs of skeletal fluorosis
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Fluoride & Spontaneous Hip Fractures in Osteoporosis Patients
Due to its ability to increase vertebral bone mass, fluoride has been used as an experimental treatment for osteoporosis (doses > 20 mg/day). Fluoride treatment, however, proved far more harmful than beneficial. Not only was fluoride therapy shown to increase fracture rates among the treated patients, it was also found to
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The Relationship Between Fluoride, Bone Density, and Bone Strength
Although fluoride has generally been found to reduce the bone density of cortical bone, it is well documented that fluoride can increase the density of trabecular bone (aka cancellous bone). Trabecular bone is the primary bone of the spine, whereas cortical bone is the primary bone of the legs and arms. While increases in
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Mechanisms by which fluoride may reduce bone strength
Based on a large body of animal and human research, it is now known that fluoride ingestion can reduce bone strength and increase the rate of fracture. There are several plausible mechanisms by which fluoride can reduce bone strength. As discussed below, these mechanisms include: Reduction in Cortical Bone Density De-bonding of
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"Pre-Skeletal" Fluorosis
As demonstrated by the studies below, skeletal fluorosis may produce adverse symptoms, including arthritic pains, clinical osteoarthritis, gastrointestinal disturbances, and bone fragility, before the classic bone change of fluorosis (i.e., osteosclerosis in the spine and pelvis) is detectable by x-ray. Relying on x-rays, therefore, to diagnosis skeletal fluorosis will invariably fail to protect those individuals who are suffering from the pre-skeletal phase of the disease. Moreover, some individuals with clinical skeletal fluorosis will not develop an increase in bone density, let alone osteosclerosis, of the spine. Thus, relying on unusual increases in spinal bone density will under-detect the rate of skeletal fluoride poisoning in a population.
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