Skeletal Sclerosis Due to Chronic Fluoride Intoxication

Abstract

Marked diffuse skeletal sclerosis was observed in 8 adult tuberculous patients treated in a Lebanese sanatorium. Each had lived for more than 10 years in Qatar, an Arabian sheikdom on the Persian Gulf. No similar bone changes were noted in other patients in the same sanatorium. Rib specimens were obtained during thoracotomy from 2 of these patients. Osteosclerosis appeared to be the result of successive linear zones of cortical and lamellar new bone formation simulating histologically the sclerotic changes seen in Paget''s disease. These two patients showed a significant elevation of serum alkaline phosphatase. Tne fluoride content of defatted and ashed rib samples obtained from the two Qatari patients ranged between 0.843 and 1.052% (normal controls 0.038 to 0.0419c). The fluoride concentration in drinking water samples obtained from Qatar ranged between 0.80-3.45 ppm. These observations indicate that there is an area of endemic fluorosis in the region of the Persian Gulf where the fluoride concentration in drinking water is less than four parts per million. It is postulated that certain local factors, such as hot climate, malnutrition, excessive drinking of tea, all contribute to the severity of fluorosis.