Recovery From Skeletal Fluorosis (an Enigmatic, American Case)

A 52‐year‐old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow‐up documented considerable correction of the disorder after removal of the putative...

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Bibliographic Details
Published in:Journal of bone and mineral research 2007-01, Vol.22 (1), p.163-170
Main Authors: Kurland, Etah S, Schulman, Rifka C, Zerwekh, Joseph E, Reinus, William R, Dempster, David W, Whyte, Michael P
Format: Article
Language:English
Subjects:
Biological and medical sciences
Biopsy
bone densitometry
Bone Density
bone histomorphometry
bone turnover markers
Cervical Vertebrae - diagnostic imaging
enthesopathy
fluoride
Fluoride Poisoning - diagnostic imaging
Fluorides - blood
Fundamental and applied biological sciences. Psychology
Humans
Ilium - pathology
Male
Middle Aged
nephrolithiasis
osteoarthritis
osteosclerosis
Radiography
Skeleton and joints
Spinal Cord Diseases - diagnostic imaging
toothpaste
Toothpastes - toxicity
Vertebrates: osteoarticular system, musculoskeletal system
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Summary:A 52‐year‐old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow‐up documented considerable correction of the disorder after removal of the putative source of fluoride (toothpaste). Introduction: Skeletal fluorosis, a crippling bone disorder, is rare in the United States, but affects millions worldwide. There are no data regarding its reversibility. Materials and Methods: A white man presented in 1996 with neck immobility and worsening joint pains of 7‐year duration. Radiographs revealed axial osteosclerosis. Bone markers were distinctly elevated. DXA of lumbar spine (LS), femoral neck (FN), and distal one‐third radius showed Z scores of +14.3, +6.6, and −0.6, respectively. Transiliac crest biopsy revealed cancellous volume 4.5 times the reference mean, cortical width 3.2 times the reference mean, osteoid thickness 25 times the reference mean, and wide and diffuse tetracycline uptake documenting osteomalacia. Fluoride (F) was elevated in serum (0.34 and 0.29 mg/liter [reference range:
ISSN:0884-0431
1523-4681
DOI:10.1359/jbmr.060912