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Skeletal fluorosis: don’t miss the diagnosis!

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Abstract

Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fixation of fluoride. The disease occurs as an endemic problem in some parts of the world and is the result of prolonged ingestion or rarely by inhalation of high amounts of fluoride. Radiographic presentation is mainly characterized by bone changes with osteocondensation and later ossification of many ligaments and interosseous membranes. Skeletal fluorosis is not clinically obvious and can be confused with other rheumatologic disorders. Its severity lies in the development of skeletal deformities and neurological complications. Management of fluorosis generally focuses on symptom treatment.

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References

  1. Datta P, Datta PP. Prevalence, etiology and clinical features of skeletal fluorosis: a critical review. Innovare J Med Sci. 2013;1:5–6.

  2. Tamer MN, KaleKoroglu B, Arslan C, et al. Osteosclerosis due to endemic fluorosis. Sci Total Environ. 2007;373:43–8.

    Article  CAS  Google Scholar 

  3. Chen J, Liu G, Kang Y, et al. Coal utilization in China: environmental impacts and human health. Environ Geochem Health. 2014;36:735–53.

    Article  CAS  Google Scholar 

  4. Majumdar KK. Health impact of supplying safe drinking water containing fluoride below permissible level on flourosis patients in a fluoride-endemic rural area of West Bengal. Indian J Public Health. 2011;55:303–8.

    Article  Google Scholar 

  5. Kurdi MS. Chronic fluorosis: the disease and its anaesthetic implications. Indian J Anaesth. 2016;60:157–62.

    Article  CAS  Google Scholar 

  6. Gupta N, Gupta N, Chhabra P. Image diagnosis: dental and skeletal fluorosis. Perm J. 2016;20:105–6.

    Google Scholar 

  7. Laatar A, Mrabet D, Zakraoui L. Fluorosis in sub-Saharan Africa. Rev Rhum. 2003;70:178–82.

    Article  Google Scholar 

  8. Guissouma W, Hakamic O, Rajab AJ, Tarhounia J. Risk assessment of fluoride exposure in drinking water of Tunisia. Chemosphere. 2017;177:102–8.

    Article  CAS  Google Scholar 

  9. Reber JD, McKenzie GA, Broski SM. Voriconazole -induced periostitis: beyond post-transplant patients. Skelet Radiol. 2016;45:839–42.

    Article  Google Scholar 

  10. Arlappa N, Aatif IQ, Srinivas R. Fluorosis in India: an overview. Int J Res Dev Health. 2013;1:97–102.

    Google Scholar 

  11. Liu Q, Liu H, Yu X, et al. Analysis of the role of insulin signaling in bone turnover induced by fluoride. Biol Trace Elem Res. 2016;171:380–90.

    Article  CAS  Google Scholar 

  12. Pei J, Li B, Gao Y, et al. Fluoride decreased osteoclastic bone resorption through the inhibition of NFATc1 gene expression. Environ Toxicol. 2014;29:588–95.

    Article  CAS  Google Scholar 

  13. Teotia SP, Teotia M, Singh KP (2004) Highlights of forty years of research on endemic skeletal fluorosis in India. 4th International Workshop on Fluorosis Prevention and Defluoridation of Water. Colombo, Sri Lanka; March 2–6.

  14. Pramanik S, Saha D. The genetic influence in fluorosis. Environ Toxicol Pharmacol. 2017;56:157–62.

    Article  CAS  Google Scholar 

  15. del Carmen Aguilar-Diaz F, Federico Morales-Corona F, Cintra-Viveiro AC, Fuente-Hernández J. Prevalence of dental fluorosis in Mexico 2005-2015: a literature review. Salud Publica Mex. 2017;59:306–13.

    Article  Google Scholar 

  16. Neurath C, Limeback H, Osmunson B, Connett M, Kanter V, Wells CR. Dental fluorosis trends in US oral health surveys: 1986 to 2012. JDR Clinical and translational Research; 2019. https://doi.org/10.1177/2380084419830957

    Article  CAS  Google Scholar 

  17. Pendrys DG. The differential diagnosis of fluorosis. J Public Health Dent. 1999;59:235–8.

    Article  CAS  Google Scholar 

  18. Liu J, Fu Z, WU L, Ding H, Wang D-l, YU B-l. The Imaging Value of Bone Turnover of Skeletal Fluorosis. Foreign medical sciences (section of medgeography). 2004;25(2):95–98.

  19. Roholm K. Fluorine intoxication: a clinical hygienic study. London: Lewis; 1937.

    Google Scholar 

  20. Izuora K, Twombly JG, Whitford GM, Demertzis J, Pacifici R, Whyte MP. Skeletal fluorosis from brewed tea. J Clin Endocrinol Metab. 2011;96:2318–24.

    Article  CAS  Google Scholar 

  21. Bisseret D, Kaci R, Lafage-Proust MH, Alison M, Parlier-Cuau C, Laredo JD, et al. Periosteum: characteristic imaging findings with emphasis on radiologic-pathologic comparisons. Skelet Radiol. 2015;44:321–38.

    Article  Google Scholar 

  22. Ramakrishna K, Sasikiran NO. Fluorosis-an update. Int J Res Pharmaceut. Biomed Sci. 2013;4:1084–8.

    Google Scholar 

  23. Subbarao K. Musculoskeletal fluorosis-imaging spectrum. J Med Sci Res. 2013;1:117–23.

    Article  Google Scholar 

  24. Yildiz M, Akdoğan M, Tamer N, Oral B. Bone mineral density of the spine and femur in early postmenopausal Turkish women with endemic skeletal fluorosis. Calcif Tissue Int. 2003;72:689–93.

    Article  CAS  Google Scholar 

  25. Numan Tamer M, Kale Köroğlu B, Arslan C, Akdoğan M, Köroğlu M, Çam H, et al. Osteosclerosis due to endemic fluorosis. Sci Total Environ. 2007;373:43–8.

    Article  CAS  Google Scholar 

  26. Winn N, Lalam R, Cassar-Pullicino V. Imaging of Paget's disease of bone. Wien Med Wochenschr. 2017;167:9–17.

    Article  Google Scholar 

  27. John DR, Suthar PP. Radiological features of long-standing hypoparathyroidism. Pol J Radiol. 2016;81:42–5.

    Article  Google Scholar 

  28. Jimenez-Garcia R, del Barrio J, Hernandez-Barrera V, Miguel-Díez J, Jimenez-Trujillo I, Martinez-Huedo M. Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study. J Pain Res. 2018;11:1005–15.

    Article  Google Scholar 

  29. Kumar H, Boban M, Tiwari M. Skeletal fluorosis causing high cervical myelopathy. J Clin Neurosci. 2009;16:828–30.

    Article  Google Scholar 

  30. Wang W, Kong L, Zhao H, et al. Thoracic ossification of ligamentum flavum caused by skeletal fluorosis. Eur Spine J. 2007;16:1119–28.

    Article  Google Scholar 

  31. Di Giovanni T, Eliades T, Papageorgiou SN. Interventions for dental fluorosis: a systematic review. J Esthet Restor Dent. 2018;30:502–8.

    Article  Google Scholar 

  32. Khairnar MR, Dodamani AS, Jadhav HC, Naik RG, Deshmukh MA. Mitigation of fluorosis—a review. J Clin Diagn Res. 2015;9:ZE05–9.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Radiology Department, Orthopaedic Institute M T Kassab, University of Tunis El Manar- Faculty of Medicine of Tunis, Ksar Said, 2010, Manouba, Tunisia

    Meriem Sellami, Hend Riahi, Mouna Chelli Bouaziz & Mohamed Fethi Ladeb

  2. Rheumatology Department, Orthopaedic Institute M T Kassab, University of Tunis El Manar- Faculty of Medicine of Tunis, Manouba, Tunisia

    Kaouther Maatallah & Hanen Ferjani

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  1. Meriem Sellami
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  2. Hend Riahi
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Correspondence to Meriem Sellami.

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Sellami, M., Riahi, H., Maatallah, K. et al. Skeletal fluorosis: don’t miss the diagnosis!. Skeletal Radiol 49, 345–357 (2020). https://doi.org/10.1007/s00256-019-03302-0

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  • DOI: https://doi.org/10.1007/s00256-019-03302-0

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