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The continuing crippling challenge of skeletal fluorosis – Case series and review of literature.

3.2. Bone biochemistry Among the nine subjects with fluorosis, 5/9(Patient Number 1 to 5) (55.5%) had vitamin D deficiency and 4/9 (44.4%) had secondary hyperparathyroidism. Five patients(Patient Number 1 to 5) were also noted to have a component of osteomalacia as reflected by the elevated alkaline phosphatase. The mean(SD) urine fluoride was 2.9(1.4) ppm. The other bone biochemical parameters and urine fluoride are depicted in Table 2.