Full Text:

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.

Print PDF

• Related Studies :

  • 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

  • Fluorosis induced by drinking brick tea

    Fluorosis in China has been known to be induced by two main causes. One is water-dependent fluorosis caused by a long-time consumption of high-fluoride (F) containing water. The other is called "coal-burning type fluorosis", caused by inhalation of air polluted by coal smoke and/or ingestion of food exposed to coal

  • 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

  • Brick tea fluoride as a main source of adult fluorosis

    An epidemiological survey was conducted in Naqu County, Tibet in September 2001 to investigate the manifestations of fluorosis in adults caused by the habitual consumption of brick tea. Profiles were obtained for the total daily fluoride intake, environmental fluoride levels and average urinary fluoride concentration, and a physical examination and a

  • Dose-response relationship between skeletal fluorosis and fluoride in brick-tea

    The dose-response relationship between fluoride in brick-tea and the prevalence of skeletal fluorosis (SF) in adults was studied to determine a safe upper limit for fluoride intake from brick-tea. In brick-tea drinking endemic fluorosis areas of the Tibetan pastoral areas of Sichuan province, cluster sampling was conducted of residents above age

• Related FAN Content :

  • Exposure Pathways Linked to Skeletal Fluorosis

    Excessive fluoride exposure from any source -- and from all sources combined -- can cause skeletal fluorosis. Some exposure pathways , however, have been specifically identified as placing individuals at risk of skeletal fluorosis. These exposure pathways include: Fluoridated Water for Kidney Patients Excessive Tea Consumption High-Fluoride Well Water Industrial Fluoride Exposure Fluorinated Pharmaceuticals (Voriconazole

  • 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.

  • 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.

  • "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.

  • 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