Abstract
Previously by the time skeletal fluorosis among aluminum smelter workers due to high fluoride exposure was diagnosed numerous cases of bone fluorosis had already reached stages II and III according to Roholm. Today, as a result of improved working conditions and continuous health care, the picture has changed. This paper reports the frequency of occurrence of bone changes caused by fluoride in a population of 358 aluminum smelter workers who had been fluoride exposed for more than 5 years and whose diagnosis had not been made prior to 1971. In the examination, particular attention was paid to degenerative changes of the skeleton and the frequency of spondylosis, arthrosis of the hip and elbow joints as well as changes in the form of diffuse idiopathic skeletal hyperostosis (spondylosis hypeostotica Forestier). A population of 81 foundry workers in aluminum smelters under similar working conditions, but not fluoride exposed, served as controls.
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Comparison of rheumatoid (ankylosing) spondylitis and crippling fluorosis
(1) Fluoride concentrations were determined for autopsy samples of rib, sacrum, ilium, vertebra, adhering soft tissue, and rib marrow from a patient suffering from rheumatoid (ankylosing) spondylitis of 10 years’ duration. The fluoride concentrations were not increased above normal levels. In this case, the increased bone density seen in this
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Radiological criteria of industrial fluorosis
The bone radiographs of 43 potroom workers in an aluminium factory, on whom the diagnosis of industrial fluorosis had been confirmed by bone biopsy, are compared with radiographs from 18 control subjects. A higher frequency of ossification of ligament, tendon, and muscle attachments is observed among the fluoride exposed subjects.
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Industrial skeletal fluorosis: preliminary report on 61 cases from aluminum smelter
SchIegel presented data on 61 cases of skeletal f1uorosis among workers of a Swiss aluminum factory. Of 350 cases ofìndustrial fluorosis reported in the world's literature, approximately 20 occcured in the smelting area of the aluminum industry. For processing aluminum from clay, cryolite (NaAlF6) is used as a fluxing agent.
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Industrial fluorosis [Boillat et al.]
43 potroom workers (aluminium industry) with fluorosis have been compared with 18 foundry workers of the same age, but who had never been exposed to fluorides. Clinical examination revealed a higher incidence of articular pain and limitation of motion in the exposed group. The diagnosis of fluorosis is not only
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[Two cases of skeletal fluorosis in the hand].
Skeletal fluorosis is well known, particularly in the spine, pelvis and forearm. However, the hand may also be involved. The authors report two cases of this site in endemic areas in Senegal, after ingestion of large amounts of fluoride in the water. Fluorosis consisted of deforming metacarpal and phalangeal osteoperiotitis in one case
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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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"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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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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Estimated "Threshold" Doses for Skeletal Fluorosis
For over 40 years health authorities stated that in order to develop crippling skeletal fluorosis, one would need to ingest between 20 and 80 mg of fluoride per day for at least 10 or 20 years. This belief, however, which played an instrumental role in shaping current fluoride policies, is now acknowledged by the National Academy of Sciences (NAS) and other US health authorities to be incorrect.
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