Physical Properties of Fluorosis Bone

Franke, Jennifer; Runge, H.; Grau, P.; Fengler, Felipe Hashimoto; Wanka, C; Rempel, H

doi:10.3109/17453677608998967

Cited by 39 publications

(8 citation statements)

References 11 publications

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“…The tensile strength of bone in patients with severe fluorosis is decreased,20 21 and there is an enlargement of periosteocytic lacunar surfaces and excess cortical porosity.7 In contrast, bone strength is increased in patients with moderate fluorosis21that is, in those with a sodium fluoride intake of less than 60 mg a day' and normal renal function.…”

Section: Discussionmentioning

confidence: 99%

Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis.

Gerster¹,

Charhon²,

Jaeger³

et al. 1983

BMJ

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Case reportsTwo patients with moderate renal failure sustained spontaneous bilateral hip fractures during treatment with fluoride, calcium, and vitamin D for osteoporosis. They had been taking sodium fluoride (40-60 mg/day) for 11 and 21 months, respectively. Histological examination of a specimen of the bone showed severe fluorosis in the first case, and quantitative analysis of bone showed osteomalacia and skeletal fluorosis in the other case. These abnormalities were considered to be the consequence of excessive retention of fluoride due to renal insufficiency.As bilateral femoral neck fractures are very rare these data suggest a causal link between fractures and fluoride in patients with renal failure. Thus fluoride should be given at a lower dosage, if at all, to patients with even mild renal failure. Introduction Fluoride, combined with calcium and vitamin D is effective in preventing new vertebral crush fractures not only in primary' but also in corticosteroid induced osteoporosis.2 Fractures of long bones have been described, however, during fluoride treatment, and 13 cases of fracture of the femoral neck, none of them bilateral, have been reported; the cause and effect relation has not been clearly established.4 6 We report on two patients with osteoporosis in whom bilateral hip fractures occurred spontaneously after 11 and 21 months of treatment with fluoride; the two patients suffered from moderate chronic renal insufficiency.

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Section: Discussionmentioning

confidence: 99%

Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis.

Gerster¹,

Charhon²,

Jaeger³

et al. 1983

BMJ

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“…It has been shown in animals treated with fluoride and in humans with fluorosis that osteoid seams thicken and mineralization is increased, resulting in denser bone tissue. However, this kind of bone may have histological features of osteomalacia, and its physical properties may be abnormal (Riggins et al 1974, Yamamoto et al 1974 Franke et al 1976). Bernstein et al (1966) stated in their epidemiological study that osteoporotic fractures were fewer in areas where the fluoride content of the drinking water was high, compared with areas where is was low.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Drinking Water Fluoridation on the Fluoride Content, Strength and Mineral Density of Human Bone

Alhava

Olkkonen

Kauranen

et al. 1980

Acta Orthopaedica Scandinavica

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“…By contrast, Schulz et al (46) found no significant change in femoral shaft cortical density determined by quantitative computed tomography. Franke et al (47) found that moderatefluorosis increases all parameters of strength and hardness of bone, but that severe fluorosis increased the mechanical properties of trabecular bone in vertebrae while decreasing the mechanical properties of femoral cortical bone (reviewed by Carter and Spenglerv'").…”

Section: Acknowledgmentsmentioning

confidence: 99%

Journal of Bone and Mineral Research

Gutteridge

Price

Kent

et al. 1990

Journal of Bone and Mineral Research

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Spontaneous fractures were reported to be rare (less than 1%) in 1664 hospital admissions for hip fracture in the 1950s in Sweden. We report 11 fluoride-treated postmenopausal patients who developed spontaneous fractures of the femoral necks, all subcapital initially. In 7 patients who continued treatment there were later femoral neck or shaft fractures; in 6, these were bilateral (one followed a fall). In all there were 19 spontaneous fractures: 5 were asymptomatic, including 2 with deformity; 12 fractures required surgery. Five were incomplete (stress) fractures. All were treated with supplementary calcium 1 g daily; 10 had vitamin D supplementation. In all patients where the timing was known, the initial and subsequent fractures were preceded by, or associated with increased bone turnover as measured by plasma alkaline phosphatase (pAlP) (i.e., they were all "good responders"). Two had pretreatment hip fractures following falls. We compared these 11 (Group 1) and another identically treated group of 14 patients (Group 2), without spontaneous femoral fractures and not different in mean age, pretreatment vertebral fractures, years since menopause, fluoride dosage, and plasma creatinine. Group 1 had a lower (p less than 0.05) index of cortical bone in the femoral neck, as assessed by the ratio "calcar width/femoral neck minimum width." The 6 biopsied fluorotic patients from Group 1 had a higher (p less than 0.05) bone fluoride content than the 4 biopsied fluorotic patients from Group 2. Furthermore, histological cortical features of thinning, increased porosity, and advanced tunneling resorption characterized Group 1 posttreatment biopsies. There were no significant differences in peak pAlP responses in the two groups. Mild asymptomatic vitamin D excess may have been a contributing factor in three Group 1 patients. Two further treatment groups have been studied more recently by forearm single-photon absorptiometry (SPA) at two sites; a cyclic NaF group (Group 3) and a calcium +/- vitamin D group (Group 4). Neither showed significant changes in forearm cortical bone density on treatment for 2 and 1.5 years, respectively, but Group 3 showed a significant increase in density at an ultradistal (60% trabecular) site. The pAlP response in Group 3 was significantly less than in Group 1. Spontaneous femoral neck or shaft fractures did not occur in either Groups 3 or 4. Therefore, we recommend: (1) Avoidance of sodium fluoride (NaF) treatment if pretreatment femoral fracture or thin femoral neck cortices exist.(ABSTRACT TRUNCATED AT 400 WORDS)

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Physical Properties of Fluorosis Bone

Cited by 39 publications

References 11 publications

Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis.

Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis.

The Effect of Drinking Water Fluoridation on the Fluoride Content, Strength and Mineral Density of Human Bone

Journal of Bone and Mineral Research

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