A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography of the spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). The condition can be treated with –
Correct Answer: Change in source of water
Description: Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride in the bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints. Symptoms are mainly promoted in the bone structure. Due to a high fluoride concentration in the body, the bone is hardened and thus less elastic, resulting in an increased frequency of fractures. Other symptoms include thickening of the bone structure and accumulation of bone tissue, which both contribute to impaired joint mobility. Ligaments and cailage can become ossified.Most patients suffering from skeletal fluorosis show side effects from the high fluoride dose such as ruptures of the stomach lining and nausea. Fluoride can also damage the parathyroid glands, leading to hyperparathyroidism, the uncontrolled secretion of parathyroid hormones. These hormones regulate calcium concentration in the body. An elevated parathyroid hormone concentration results in a depletion of calcium in bone structures and thus a higher calcium concentration in the blood. As a result, bone flexibility decreases making the bone more susceptible to fractures As of now, there are no established treatments for skeletal fluorosis patients.However, it is reversible in some cases, depending on the progression of the disease. If fluorine intake is stopped, the amount in bone will decrease and be excreted urine. However, it is a very slow process to eliminate the fluorine from the body completely. Minimal results are seen in patients. Treatment of side effects is also very difficult. For example, a patient with a bone fracture cannot be treated according to standard procedures, because the bone is very brittle. In this case, recovery will take a very long time and a pristine healing cannot be guaranteed. However, fuher fluorosis can be prevented by drinking defluoridated water. It is recently suggested that drinking of defluoridated water from the ''calcium amended-hydroxyapatite'' defluoridation method may help in the fluorosis reversal.Defluoridated water from this suggested method provides calcium-enriched alkaline drinking water as generally fluoride contaminated water has a low amount of calcium mineral and drinking alkaline water helps in eliminating the toxic fluoride from the body Ref Davidson 23rd edition pg 716
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