In a study of workers exposed to cryolite (sodium aluminum fluoride) dust for many years, Roholm (1) found that some had severe chronic skeletal fluorosis but that in a greater number there was radiologic evidence of osteosclerosis which was not associated with symptoms. This observation led Rich and Ensinck (2) to administer sodium fluoride to patients with rarefying disorders of the skeleton in the belief that the production of a mild degree of asymptomatic osteosclerosis would strengthen the bone. Since then, several investigators have reported their experiences with sodium fluoride therapy in patients with osteoporosis (3-5), osteitis deformans (3, 6,…
Page 1154: “In some animals sodium fluoride causes severe renal damage; renal tubular damage and renal insufficiency have been reported in endemic fluorosis (16).These renal effects of fluorine may be important, particularly when long-term therapy is contemplated. The presence of pre-existing renal disease may also influence the response to the drug, because the kidney is the principal route of fluorine excretion. A patient with renal disease (probably chronic pyelonephritis) has been reported (17) whose bone contained fluorine in a concentration exceeding 5,000 ppm. There was no history of exposures to fluorides, and her usual drinking water contained less than 0.5 ppm of fluorine. This is of interest because in a postmortem study in Utah (18) the highest concentrations of fluorine were found in those with chronic pyelonephritis; this was not true of those with chronic glomerulonephritis. It is hard to explain these findings but in chronic pyelonephritis there is commonly a defect of water conservation with polyuria and polydipsia, and this may be the important factor. Sauerbrunn and associates have reported in this issue of the ANNALS the development of skeletal fluorosis in a patient with chronic polydipsia; the fluorine content of his drinking water was high but it was not at a level generally associated with the production of skeletal disorder. It seems probable that in this patient and in those with chronic pyelonephritis the high concentrations of fluorine found in the bone are the result of a greater consumption of water, which leads to a greater intake of fluorine.”
16. Singh, A., Jolly, S. S., Bansal, B.C., Mathur, C.C.: Endemic fluorosis. Epidemiological, clinical and biochemical study of chronic fluorine intoxication in Punjab (India). Medicine (Balt.) 43: 229, 1963.
17. Taves, D.R., Terry, R., Smith, F.A., Gardner, D.E.: Use of fluoridated water in long-term hemodialysis. Arch. Intern. Med. (Chicago) 115: 167, 1965.
18. Call., R.A., Greenwood, D.A., LeCheminant, W.H. Shupe, J.L., Nielsen, H.M., Olson, L.E., Lamborn, R.E., Mangelson, F.L., Davis R.V.: Histological and chemical studies in man on effects of fluoride. Public Health Rep. 80: 529, 1965.