Skeletal fluorosis

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Skeletal fluorosis
ICD-10 M85.1
ICD-9 733.9

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Skeletal fluorosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Skeletal fluorosis is a bone disease exclusively caused by excessive consumption of fluoride.

Causes

Common causes of fluorosis include inhalation of fluoride dusts/fumes by workers in industry, use of coal as an indoor fuel source (a common practice in China), consumption of fluoride from drinking water, and consumption of fluoride from the drinking of tea, particularly brick tea.

In some areas, skeletal fluorosis may be endemic. In India, the most common cause of fluorosis is fluoride-laden water derived from deep borewells.

Epidemiology and Demographics

While fluorosis is most severe and widespread in the two largest countries - India and China - UNICEF estimates that "fluorosis is endemic in at least 25 countries across the globe. The total number of people affected is not known, but a conservative estimate would number in the tens of millions." [1]

Skeletal fluorosis in China and India

In China, the World Health Organization recently estimated that 2.7 million people have the crippling form of skeletal fluorosis, while in India, 17 of its 32 states have been identified as "endemic" areas, with an estimated 66 million people at risk and 6 million people seriously afflicted.

According to scientific surveys, skeletal fluorosis in India and China occurs when the fluoride concentration in water exceeds 1 part per million (ppm), and has been found to occur in communities with only 0.7 part per million.[2]

The Chinese government now considers any water supply containing over 1 ppm fluoride a risk for skeletal fluorosis.[2]

Skeletal fluorosis in the United States

In the United States, an average of 1 ppm of fluoride is intentionally added to water supplies for water fluoridation. The Maximum Contaminant Level (as established by the US Environmental Protection Agency) is 4 ppm.[3]

Diagnosis

Skeletal fluorosis phases

Osteosclerotic phase Ash concentration (mgF/kg) Symptoms and signs
Normal Bone 500 to 1,000 Normal
Preclinical Phase 3,500 to 5,500 Asymptomatic; slight radiographically-detectable increases in bone mass
Clinical Phase I 6,000 to 7,000 Sporadic pain; stiffness of joints; osteosclerosis of pelvis and vertebral spine
Clinical Phase II 7,500 to 9,000 Chronic joint pain; arthritic symptoms; slight calcification of ligaments' increased osteosclerosis and cancellous bones; with/without osteoporosis of long bones
Phase III: Crippling Fluorosis 8,400 Limitation of joint movement; calcification of ligaments of neck vertebral column; crippling deformities of the spine and major joints; muscle wasting; neurological defects/compression of spinal cord

References

  1. UNICEF - Water, environment and sanitation - Common water and sanitation-related diseases. Retrieved on 2007-09-17.
  2. 2.0 2.1 Bo Z, Mei H, Yongsheng Z, Xueyu L, Xuelin Z, Jun D (2003). "Distribution and risk assessment of fluoride in drinking water in the west plain region of Jilin province, China". Environmental geochemistry and health 25 (4): 421-31. PMID 14740986.
  3. U.S.P.H.S. "Review of Fluoride, Benefits and Risks", 1991. Retrieved on 2007-09-17.


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