Skeletal fluorosis in 32-year-old

Skeletal Fluorosis
On examination, he had yellowish-brown tooth discoloration (Panel A) and restricted movements of the cervical spine, hips, and shoulders. Pelvic radiography showed osteosclerosis without sacroiliitis (Panel B). Radiography of both forearms showed interosseous membrane calcification (Panel C, arrowhead).

Case study: skeletal fluorosis

A 32-year-old male patient presented to the rheumatology clinic with chronic lower back pain and stiffness in the neck, shoulders and hips. Examination showed that the patient had yellowish-brown tooth discolouration with restricted movements of the cervical spine, hips and shoulders. The patient was diagnosed with skeletal fluorosis.

Doctors referred the patient for a pelvic radiography which was significant for osteosclerosis without sacroiliitis. Laboratory tests were significant for increased alkaline phosphatase level and parathyroid hormone level. However, the levels of creatinine, calcium and vitamin D were within normal range. Doctors suspected skeletal fluorosis because the patient lived in an area with high levels of fluoride in the groundwater. Radiography of both the forearms showed interosseous membrane calcification. Serum fluoride levels were also high, whereas 24-hour urinary fluoride excretion was 7.5 ppm. These findings confirmed the diagnosis of skeletal fluorosis.

Treatment and prognosis

Doctors advised the patient to defluorinate his drinking water and treated him with calcium, vitamin D and nonsteroidal antiinflammatory drugs. Two years later the patient reported a 50% reduction in pain and stiffness.

Endemic skeletal fluorosis is a chronic metabolic diseases of the bone and joints caused because of ingesting large amounts of fluoride, especially through water. Fluoride is a toxin that alters the resorption of bone tissue. Similarly, also affects homeostasis of bone mineral metabolism. The clinical course of disease is characterised with immobilisation of joints of the axial skeleton and major joints of the extremities. In some cases, the characteristic bone changes are also accompanies with secondary hyperparathyroidism.

In most cases of skeletal fluorosis, serum parameters rarely help with diagnosis. Common indicators of fluoride toxicity include elevated urinary fluoride and increased bone fluoride content. Fluorosis, although crippling, is a preventable disease. But there is no effective therapeutic agent available for treatment of the disease. While the disease is on the increase globally, early diagnosis significantly depends on bone density measurement.

Source: NEJM

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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