Abstract
Fluorotic changes in bones and joints were evaluated in 105 aluminum workers and 20 residents of an endemic fluorosis region in India. The age of the workers averaged 51.2 years, and the duration of their exposure 18.2 years. The skeletal changes in the aluminum workers exhibited the same characteristics as those of endemic fluorosis. In industrial fluorosis the changes were less advanced than in endemic fluorosis. Generalized sclerosis, alterations in the bone structure and periosteal reactions are the most typical features of skeletal fluorosis; ossification of the interosseous membranes and muscle attachments, are less characteristic.
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Epidemiological, clinical, and biochemical study of endemic dental and skeletal fluorosis in Punjab
The incidence of dental fluorosis in 46,000 children in the Punjab was assessed and compared with the fluoride content of their water supplies. Ten villages were selected for more detailed studies of skeletal as well as dental fluorosis. Factors other than the fluoride content of the drinking water which were found to influence
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Secondary hyperparathyroidism in patients with endemic skeletal fluorosis
Investigation of 20 patients with skeletal fluorosis showed that five had clear evidence of secondary hyperparathyroidism. The hyperactivity of the parathyroid glands in skeletal fluorosis in the presence of decreased solubility of the bone mineral (fluoroapatite) strongly suggests that it is a compensatory attempt to maintain a normal extracellular ionized calcium equilibrium. Further study
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A case of bone fluorosis of undetermined origin
After predominant theories on the causes of fluorosis are described and remarks made about the metabolism of fluoride, an observation of bone fluorosis in a 64-year-old patient is reported. Because, despite painstaking research, none of the known causes of bone fluorosis could be found in our patient, a new pathomechanism is being offered for discussion, i.e.,
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Skeletal fluorosis from eating soil
A woman with chronic pyelonephritis developed progressive muscular weakness and bone pain. For twenty years she had habitually ingested fluoride-rich soil. Osteosclerosis was found on x-ray examination, and fluorosis was confirmed by bone biopsy. Renal failure augmented skeletal retention of excessive fluoride intake which, in turn, appears to have intensified symptomatic renal
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Circulating levels of immunoreactive parathyroid hormone in endemic genu valgum
Circulating levels of immunoreactive parathyroid hormone (PTH) were estimated in fifteen normal subjects and twenty-five subjects suffering from the skeletal fluorosis, ten of whom had associated endemic genu valgum. Levels of PTH were high in all the subjects with fluorosis as compared to normals, but among fluorosis subjects, those who had endemic genu valgum had
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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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"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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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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Industrial Fluorosis
A highly significant relationship of exposure to fluoride was established with the frequency of back and neck surgery, fractures, symptoms of musculoskeletal disease and past history of diseases of bones and joints in the absence of the typical findings of skeletal fluorosis. Monitoring exposed workers for the early manifestations of "musculoskeletal fluorosis" is recommended prior to the development of destructive and degenerative changes of the skeleton.
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