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A 47-year-old woman was referred for bone pain and abnormal findings on radiography. The patient reported that for the past 17 years, she has habitually consumed a pitcher of tea made from 100 to 150 tea bags daily (estimated fluoride intake, >20 mg per day). She reported a 5-year history of pain in the lower back, arms, legs, and hips. Because of brittleness, all her teeth had been extracted. Radiography of the forearm revealed interosseous membrane calcifications (Panel A, arrows), and radiography of the spine revealed a ruggerjersey appearance (striated pattern of increased density in the upper and lower zones of the vertebrae) (Panel B, arrows), suggesting skeletal fluorosis. The serum fluoride concentration was 0.43 mg per liter (23 ?mol per liter; normal concentration, <0.10 mg per liter [5 ?mol per liter]). Skeletal fluorosis is endemic in areas
with high concentrations of fluoride in the drinking water, but it is rare in other parts of the world. Brewed tea has one of the highest fluoride contents among beverages in the United States. After appropriate counseling, the patient discontinued tea consumption, with improvement in her symptoms. Since it can take years to deplete skeletal fluoride, we are considering whether to increase bone remodeling with the intermittent use of teriparatide to facilitate the elimination of skeletal fluoride.
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Prolactin rs1341239 T allele may have protective role against the brick tea type skeletal fluorosis
OBJECTIVE: Prolactin (PRL) has been reported to be associated with increased bone turnover, and increased bone turnover is also a feature of skeletal fluorosis (SF). Autocrine/paracrine production of PRL is regulated by the extrapituitary promoter and a polymorphism in the extrapituitary PRL promoter at -1149 (rs1341239) is associated with disturbances
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Chronic fluoride intoxication with fluorotic radiculomyelopathy
This case of a patient with chronic fluoride intoxication, extensive osteosclerosis, and fluorotic radiculomyelopathy is believed to be the first reported froni the United States. The development of advanced fluorosis in this patient exposed to drinking vater with less than 4 ppm of fluoride was unusual and with probably a
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FRZB1 rs2242070 polymorphisms is associated with brick tea type skeletal fluorosis in Kazakhs, but not in Tibetans, China.
Skeletal fluorosis is a metabolic bone and joint disease caused by excessive accumulation of fluoride in the bones. Compared with Kazakhs, Tibetans are more likely to develop moderate and severe brick tea type skeletal fluorosis, although they have similar fluoride exposure. Single nucleotide polymorphisms (SNPs) in frizzled-related protein (FRZB) have
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Skeletal fluorosis due to excessive tea and toothpaste consumption
We describe the case of a 53-year-old woman who presented with a metatarsal fracture and was found to have a bone mineral density (BMD) T-score of +11 in the lumbar spine and +7.6 in the hip. Subsequent investigation revealed very high serum, urine and tissue fluoride levels, associated with excessive
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Skeletal fluorosis in relation to drinking water, nutritional status and living habits in rural areas of Maharashtra, India
The present study was carried out during May 2010 to December 2011 in three villages which were randomly selected from Warora tehsil of Chandrapur district which is one of the endemic district of Maharashtra. . . . All the presently available ground water samples were collected and the mean fluoride concentration
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Tea Intake Is a Risk Factor for Skeletal Fluorosis
A number of recent studies have found that heavy tea drinkers can develop skeletal fluorosis - a bone disease caused by excessive intake of fluoride.
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Estimated "Threshold" Doses for Skeletal Fluorosis
For over 40 years health authorities stated that in order to develop crippling skeletal fluorosis, one would need to ingest between 20 and 80 mg of fluoride per day for at least 10 or 20 years. This belief, however, which played an instrumental role in shaping current fluoride policies, is now acknowledged by the National Academy of Sciences (NAS) and other US health authorities to be incorrect.
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Fluoride Content of Tea
Tea, particularly tea drinks made with lower quality older leaves, contain high levels of fluoride. Because of these high levels, research has found that individuals who drink large amounts of tea can develop skeletal fluorosis -- a painful bone disease caused by excessive fluoride intake. Since skeletal fluorosis is often misdiagnosed by
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Fluoride & Osteoarthritis
While the osteoarthritic effects that occurred from fluoride exposure were once considered to be limited to those with skeletal fluorosis, recent research shows that fluoride can cause osteoarthritis in the absence of traditionally defined fluorosis. Conventional methods used for detecting skeletal fluorosis, therefore, will fail to detect the full range of people suffering from fluoride-induced osteoarthritis.
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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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