GOAL: To understand the characteristics of forearm and crus X-rays of residents from areas with varying concentrations of fluoride in their drinking water, providing evidence for diagnosis of osteofluorosis.
METHOD: Using quantificational epidemiological methods, a total of 15 villages from Qianan and Nonan Counties of Jilin Province were selected as the subjects of the investigations; these villages all had at least 50 years of history, complete records of drinking water fluoride levels for that period with stable levels, no industrial or coal-burning fluoride pollution, no other sources of fluoride, and no low-fluoride drinking water alternatives. Fluoride concentration was determined and the areas were divided into 11 fluoride concentration levels (from 0.5 to 7.0 mg/L), and then from each range subjects ages 16-60 that had lived in the area for at least 10 years were selected. We considered 5 age ranges with cutoffs at 21, 31, 41, and 51, and a random selection of 10 to 15 subjects was made from each age range and the forearm and crus of was examined by x-ray. The 0.5-1.0 mg/L group were regarded as the low fluoride (control) group, and the 1.5-7.0 mg/L range was considered the high fluoride group; the two groups were compared with respect to various x-ray signs and disease detection rates.
RESULT: The x-ray examination showed three kinds of changes: osteofluorosis, articular degeneration, and osteoporosis. Of these, articular degeneration was the most common, with the detection rates of the high fluoride group (31.55%, 153/485) higher than the low fluoride group (21.58%, 41/190), a statistically significant difference (x2=6.62,p< 0.01). Among the 675 subjects, 72 were diagnosed with osteofluorosis, with most of them occurring in the high fluoride group (x2=25.65,p< 0.01).When the fluoride concentration reaches 6.0-7.0 mg/L, the detection rate increases markedly, to 44.92% (53/118). Regardless of fluoride concentration or degree of osteofluorosis, the most prevalent x-ray sign was change to the periosteum, reaching 95.83% (69/72), articular changes were second with 79.17%, 57/72), and changes to trabecular patterns were observed least (56.94%,41/72); the differences between the three were statistically significant (x2=9.64, p<0.01). Regardless of fluoride concentration, there was degeneration of the elbow, knee, and wrist joints, the detection rate was highest for the elbow joint (17.78%, 120/675), followed by the knee (15.41%, 104/675), and wrist degeneration was observed the least (7.53%, 53/675), the differences between the three were statistically significant (x2=30.74, p<0.01). The detection rate for articular degeneration of the elbow for the high fluoride group (21.03%, 102/485) was markedly higher than the low fluoride group (9.47%, 18/190, x2=12.47, p<0.01). Of the 35 signs detectable by x-ray examination, most were found in both high and low fluoride groups; periosteal changes were rarely seen in the low fluoride group, and often seen in the high fluoride group.
CONCLUSION: The signs of osteofluorosis in detectable in x-rays are quite varied and complex, when x-rays are used for diagnosis a comprehensive analysis should be carried out based on all the various signs and an overall determination made; only then will a diagnosis be correct and reliable.
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Why did the ancient inhabitants of Palmyra suffer fluorosis?
The skeletal remains uncovered from the 2nd and 3rd century underground tombs of Palmyra, Syria, retain traces of arthritis and mottled enamel. A brown discoloration was also observed in the teeth. In order to clarify that these facts can be related to fluorosis, the teeth excavated from Tomb C and
[Two cases of skeletal fluorosis in the hand].
Skeletal fluorosis is well known, particularly in the spine, pelvis and forearm. However, the hand may also be involved. The authors report two cases of this site in endemic areas in Senegal, after ingestion of large amounts of fluoride in the water. Fluorosis consisted of deforming metacarpal and phalangeal osteoperiotitis in one case
Paleopathology of skeletal fluorosis
Skeletal fluorosis is one of a range of conditions causing excessive ossification and joint ankylosis in skeletons. It is rarely considered, however, in differential diagnoses of palaeopathological lesions. This paper considers the identification of skeletal fluorosis in a skeletal sample from the island of Bahrain, Arabian Gulf, dating to ca.
X-Ray analysis of 80 patients with severe endemic fluorosis caused by coal burning
Radiographs of 80 patients with severe endemic fluorosis of coal-burning type [CBEF] - 49 males and 31 females aged 30 to 70 years - were analysed to examine the changes to the bone substance, peripheral structure of bone, and joints. The changes to bone substance were: 1) osteosclerosis type, 62
An uncommon presentation of fluorosis
A 70 years old farmer from Yemen was referred as a case of osteoarthritis of both knees for preoperative rehabilitation procedures. Six years before he developed progressive skeletal stiffness. By 70 years he became dependent for ambulation and many other self-care activities.
He showed quadriparesis resulting from compression of spinal cord
Related FAN Content :
Skeletal Fluorosis: The Misdiagnosis Problem
It is a virtual certainty that there are individuals in the general population unknowingly suffering from some form of skeletal fluorosis as a result of a doctor's failure to consider fluoride as a cause of their symptoms. Proof that this is the case can be found in the following case reports of skeletal fluorosis written by doctors in the U.S. and other western countries. As can be seen, a consistent feature of these reports is that fluorosis patients--even those with crippling skeletal fluorosis--are misdiagnosed for years by multiple teams of doctors who routinely fail to consider fluoride as a possible cause of their disease.
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 & 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.
Variability in Radiographic Appearance of Skeletal Fluorosis
Osteosclerosis (dense bone) is the bone change typically associated with skeletal fluorosis, particularly in the axial skeleton (spine, pelvis, and ribs). Research shows, however, that skeletal fluorosis produces a spectrum of bone changes, including osteomalacia, osteoporosis, exostoses, changes resulting from secondary hyperparathyroidism, and combinations thereof. Although the reason for this radiographic variability is not yet fully understood, it is believed to relate to the dose of fluoride consumed, the individual's nutritional status, exposure to aluminum, genetic susceptibility, presence of kidney disease, and area of the skeleton examined.
Fluoride & Osteopetrosis
One of the most common radiological findings in skeletal fluorosis is osteosclerosis - a hardening of bones with a blurring of the trabecular structure. In advanced cases, the osteosclerotic form of fluorosis may closely resemble the appearance of osteopetrosis, a "marble bone" disease in which the bones are dense, but fragile and prone to fracture.