The continuing crippling challenge of skeletal fluorosis – Case series and review of literature

Abstract

Background: Skeletal fluorosis is a metabolic bone disease that results from the chronic ingestion of fluoride. Although there are national programs in place to raise awareness and curtail this disease condition, skeletal fluorosis continues to cause crippling deformities in areas where it continues to be endemic. Method: ology: An observational study was undertaken at a university-affiliated teaching hospital in southern India. Clinical, biochemical features and densitometric variables including bone mineral density (BMD) and trabecular bone score (TBS) were assessed. Results: All patients (n = 9) hailed from fluorosis-endemic Indian states and the source of drinking water was from a bore-well in all cases. The mean (±SD) age and BMI were 45.6(±11.0) years and 25.6 (±8.4) kg/m2 respectively. Dental mottling was present in five subjects. Five subjects each had vitamin D deficiency with osteomalacia. The mean (±SD) urine fluoride was 2.9(±1.4) ppm. The bone mineral density showed a sclerotic pattern, with the mean (±SD) TBS being 1.607 (±0.160). All patients were initiated on calcium and cholecalciferol supplements and those with osteomalacia were treated with calcitriol. Conclusion: While fluorosis continues to be a challenge in endemic regions, the presence of osteomalacia proves to be a treatable component of the disease condition. There seems to be an unmet need for more aggressive defluoridation techniques and the provision of safe drinking water in susceptible individuals.

Keywords

• Skeletal fluorosis
• Osteosclerosis
• Osteomalacia
• Inter-osseous membrane
• Defluoridation
• India