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Fluorosis and osteomalacia

Clinical history A 30-year-old taxicab driver presented with a 1-year history of low back pain radiating into the posterior aspect of both legs, stiffness during inactivity, and proximal upper and lower limb myalgia. Symptoms were poorly controlled with acetaminophen. The medical history was unremarkable. The patient was a vegetarian, smoked 5 cigarettes per day, and did not drink alcohol. He was born in the Punjab region of southern Asia and had lived there until moving to the United Kingdom