Among individuals with skeletal fluorosis, the fluoride-induced changes to the spine, and the accompanying symptoms, can bear a close resemblance to spondylosis and spondylitis (as well as DISH). Spondylosis is a (non-inflammatory) degenerative disease of the spine marked by bony outgrowths (spurs) which can produce nerve cord compression. Spondylitis, by contrast, is an inflammatory form of arthritis that causes inflammation in the joints between the vertebrae. Whereas spondylosis is generally asymptomatic, spondylitis generally causes significant pain and stiffness in the spine.

More than 80% of adults in the U.S. have some degree of spondylosis in their lumbar spine after the age of 40, although it is usually asymptomatic. Spondylitis is a rarer condition, affecting an estimated 129 out of 100,000 persons. Although research has repeatedly found that fluorosis can closely resemble both conditions, no careful or comprehensive research has been conducted to determine the extent to which fluoride exposure may be contributing to either condition.

Fluorosis & Spondylosis/Spondylitis:

“Ankylosing spondylitis and osteofluorosis had a remarkable similarity in their clinical and radiological features…”
SOURCE: Susheela AK, et al. (1988). Circulating levels of sialic acid and glycosaminoglycans: a diagnostic test for ankylosing spondylitis. Annals of Rheumatic Diseases 47:833-837.

“In the aluminum workers, the most frequent changes in the spine were exostoses and ossification of the ligaments. These changes did not differ in appearance from those seen in spondylarthritis or vertebral ankylosing hyperostosis.”
SOURCE: Czerwinski E, Lankosz W. (1978). Skeletal changes in industrial and endemic fluorosis. Fluoride 11:29-32.

“fluorosis is usually associated only with stiffness, backache, and joint pains which may suggest the diagnosis of rheumatism, rheumatoid arthritis, ankylosing spondylitis and osteomalacia.”
SOURCE: Teotia SPS, et al. (1976). Symposium on the Non-Skeletal Phase of Chronic Fluorosis: The Joints. Fluoride 9: 19-24.

“a 50 year old male appeared in our out-patient department complaining of pains in bones and joints, back pains, stiffness, immobility of the neck and spine, and inability to walk for the past four years. He had spent his entire life in an endemic fluorosis area. He had been treated for ankylosing spondylitis elsewhere for several months but without benefit.”
SOURCE: Teotia SPS, Teotia M. (1972). Calcification of the Vas Deferens in a patient with endemic fluorosis. Fluoride 5: 86-88.

“The vertebrae are fused at many places which explains the marked limitation of movements and the resemblance of the disease to spondylitis ankylopoietica.”
SOURCE: Jolly SS. (1970). Hydric fluorosis in Punjab. In: TL Vischer, ed. (1970). Fluoride in Medicine. Hans Huber, Bern. pp. 106-121.

“[The early cases of the disease] are usually young adults whose only complaints are vague pains most frequently in the small joints of the hands and feet, the joints of knee and spine. Such cases are common in an endemic area. They are misdiagnosed as rheumatoid arthritis or ankylosing spondylitis.”
SOURCE: Jolly SS. (1968). An epidemiological, clinical and biochemical study of endemic, dental and skeletal fluorosis in Punjab. Fluoride 1: 65-75.

“Backache: This is a common complaint and is usually proportional to the degree of calcification of the spinous, ilio-lumbar and sacro-iliac ligaments and can closely simulate ankylosing spondylitis.”
SOURCE: Kumar SP, Harper RA. (1963). Fluorosis in Aden. British Journal of Radiology 36: 497-502.

“The vertebrae were fused at many places which explained the marked limitation of movement and the resemblance of the disease to spondylitis ankylopoietica.”
SOURCE: Singh A, et al. (1963). Endemic fluorosis. Epidemiological, clinical and biochemical study of chronic fluoride intoxication in Punjab. Medicine 42: 229-246.

“The interspinous and other spinal ligaments were calcified, simulating spondylitis ankylopoietica.”
SOURCE: Singh A, et al. (1961). Skeletal fluorosis and its neurological complications. Lancet 1: 197-200.

“It has long been known that intake of fluorine in large amounts – either added to drinking water or by inhalation of fluoride-containing dust – induces a characteristic disease entity which is readily diagnosed clinically and resembles spondylosis.”
SOURCE: Rockert H, Sunzel H. (1960). Skeletal lesions following ingestion of fluoridated water. Experientia 15: 155-156.

“Crippling fluorosis and rheumatoid (anklyosing) spondylitis present a confusing similarity…”
SOURCE: Steinberg CL, et al. (1955). Comparison of rheumatoid (ankylosing) spondylitis and crippling fluorosis. Annals of the Rheumatic Diseases 14: 378-384.

“During our anthropological studies we were puzzled by the high incidence of a peculiar type of ‘arthritis’ and joint ankylosis that seemed to afflict a majority of the adult inhabitants of a number of small Miao villages in the neighbourhood. In fact, in many of the older people the disease had advanced to such an extent that they appeared to be ‘set’ in semi-sitting positions, with almost complete loss of movement in the limbs… Later a copy of Roholm’s mongraph on fluorine intoxication came to hand and we were struck by the similarity in appearance between the photographs of the Danish workers in cryolite and the crippled Miao peasants in China… It is quite possible that endemic centres [of skeletal fluorosis] exist but that the cause of the disabling spondylitis or other joint affections has not been determined, and a diagnosis of chronic arthritis has resulted. Few cases in Canada or the United States will be found to be as dramatic as that recorded here from Southwest China, but by calling attention to the advanced stage of this condition help may be afforded to the diagnosis of early cases.”
SOURCE: Kilborn LG, et al. (1950). Fluorosis with report of an advanced case. Canadian Medical Association Journal 62: 135-141.

“SUMMARY: A brief account is given of the discovery of endemic fluorosis in the province of Kweichow in China. A clinical description of 4 cases of spondylitis is given…”
SOURCE: Lyth O. (1946). Endemic fluorosis in Kweichow, China. The Lancet 1: 233-235.

“In this short series of cases we have found that disturbances in the natural ossification of the spines of children are very common. Though some of these defects probably heal or improve, we found many young adults with similar deformities and with early signs of spondylosis deformans (spondylitis osteo-arthritica). We notice that dental fluorosis is commonly associated with such changes but we have no evidence to prove that fluorine is solely responsible: changes of a similar nature, though less definite, were demonstrated in children showing no signs of dental fluorosis, and not all children with severe dental fluorosis had changes in the spine, whereas some with only slighly mottling showed significantg deformities. These results are put forward as a preliminary investigation… We believe that fluorine in the water-supply may influence the development of such defects especially when it is associated with defective nutrition.”
SOURCE: Kemp FH, et al. (1942). Spondylosis deformans in relation to fluorine and general nutrition. The Lancet 93-97.

“In the X-ray examination of the columna of the former cryolite workers a surprisingly large number of cases of spondylitis deformans of ordinary type was observed, but often of a pronounced character.”
SOURCE: Roholm K. (1937). Fluoride intoxication: a clinical-hygienic study with a review of the literature and some experimental investigations. London: H.K. Lewis Ltd.

“The ligaments on the anterior and lateral aspects of the vertebral bodies form, with their calcifications, actual bridges between the latter, in the same way as in severe cases of spondylitis deformans; and in some places the picture resulting from these calcifications exactly resembles that of a spondylitis ankylopoietica.”
SOURCE: Moller P, Gudjonsson SV. (1932). Massive fluorosis of bones and ligaments. Acta Radiologica 12: 269-294.