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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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Fluoride-related bone disease associated with habitual tea consumption
Acquired osteosclerosis is a rare disorder of bone formation but an important consideration in adults with sclerotic bones or elevated bone density results. In such patients, malignancy, hepatitis C, and fluorosis should all be considered when making a diagnosis. We describe 4 patients evaluated at our Metabolic Bone Disease Clinic
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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
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Skeletal fluorosis mimicking seronegative spondyloarthropathy: a deceptive presentation
Skeletal fluorosis is rarely recognized early and is amajor cause of morbidity.We report on a 40-year-old man with skeletal fluorosis mimicking seronegative spondyloarthropathy.
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Non-Endemic Skeletal Fluorosis: Causes And Associated Secondary Hyperparathyroidism (Case Report and Literature Review).
Highlights Fluorocarbon “huffing” is an under-appreciated cause of skeletal fluorosis (SF) We present a SF case with hyperparathyroidism, osteosclerosis, and osteomalacia SF may go undetected due to variation in symptoms, radiology, and biochemistry Dietary calcium, prior bone health, and skeletal F exposure influence SF features SF is common in
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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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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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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.
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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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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
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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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