Abstract
Case: A 72-year-old man presented for evaluation of bony prominences over extremities. Radiographic imaging demonstrated masses of varying sizes extending from the cortical surfaces without medullary continuity. The patient had a history of Freon inhalation abuse and was diagnosed with skeletal fluorosis due to elevated serum fluoride levels. He underwent an uncomplicated excision of a left fibular mass that was threatening skin breakdown.
Conclusions: This is the first reported surgical case of skeletal fluorosis demonstrating continued enlargement of bony prominences throughout the body. Skeletal fluorosis not only causes diffuse mineralization but may also lead to protruding lesions throughout the body.
*Abstract online at https://journals.lww.com/jbjscc/Abstract/2020/06000/Excision_of_Prominent_Bony_Mass_due_to_Skeletal.3.aspx
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Effects of fluoride on the proliferation and activation of osteoblasts by regulating methylation of the DNA repair genes MGMT and MLH1.
Introduction Fluoride can induce the proliferation and activation of osteoblasts, resulting in skeletal fluorosis progression; however, the specific mechanism is unclear. Methods Cell proliferation was examined using the MTT assay. Flow cytometry was performed to detect the cell cycle distribution. Alkaline phosphatase (ALP) was calculated to evaluate bone formation and turnover. Gene methylation
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Correlation of fluoride in drinking water with urine, blood plasma, and serum fluoride levels of people consuming high and low fluoride drinking water in Pakistan
A case-controlled study has compared urinary, blood plasma, and serum fluoride (F) levels of people living in endemic areas of the Thar Desert, Sindh, Pakistan, consuming groundwater with F concentrations as high as 4.00–10.00 mg/L with those consuming groundwater with low F levels of 0.30 mg/L. A total of 121
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Radiological analysis of fluorotic elbow arthritis
This article has reported the radiological signs in 109 cases of fluorotic elbow arthritis: sclerosis, irregularity and discontinuity of the articular surfaces; coarsened bone striation below the articular surface, trabecular coarsening and rarefaction, sparseness of trabeculae or density changes along with areas of cystic radiolucency. The author first suggested osteophyte
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Quantitative epidemiological research on the relationship between fluoride concentration of drinking water and endemic fluoride poisoning.
The present study analyzes the dose-response relationship that exists between the concentration of fluoride in drinking water and the clinical symptoms of fluoride poisoning. A positive correlation is observed between the fluoride content of water and the rate of dental fluorosis, skeletal x-ray change frequency, skeletal x-ray change index, and
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Endemic fluorosis with neurological complications in a Hampshire man
We describe below a case of skeletal fluorosis occurring in a Hampshire man who presented with neurological complications, and whose condition was appreciably improved by operation. We believe that this is the first case of its kind to be reported from Britain, and also the first case of skeletal fluorosis
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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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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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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.
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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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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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