Skeletal fluorosis in Vavuniya District: an observational study

Abstract

Background The WHO recommended safe upper limit for fluoride in drinking water is 1.5 mg/l. Groundwater sources in many parts of Sri Lanka often exceed this limit. The high fluoride content of groundwater and high environmental temperatures in Vavuniya District predispose to pre-skeletal fluorosis and skeletal fluorosis in adults. Objectives To identify residents of Vavuniya District with clinical features of pre-skeletal and skeletal fluorosis; to describe their clinical, biochemical and radiographic features; to determine the fluoride content of blood and urine in individuals with established diagnoses, and of their drinking water. Methods In 98 volunteers we detected 60 with clinical features of pre-skeletal and skeletal fluorosis. Clinical examination, biochemical and radiographic investigations were performed. Forty four with confounding factors were excluded. The balance 16 had radiographic investigation for fluoride bone disease, and assessment of clinical features for pre-skeletal fluorosis. The radiographic criteria of skeletal fluorosis were trabecular haziness, osteosclerosis, osteophytes, cortical thickening and ligamentous or muscle attachment ossification. All 16 had "spot" samples of 15 ml of venous blood taken for biochemical tests and fluoride estimation; and 30 ml of urine, and water from 16 dug wells for fluoride. Results The 16 selected (11 males) had BMI between 20.6 and 31.9 kg/m 2 , and were between 22 and 84 years (59.9 + 20.4). They used water from domestic dug wells for drinking. All had adequate renal function. All serum and urine samples had raised fluoride levels way above the reference ranges for serum (0.02-0.18 mg/l) and urine (0.6-2.0 mg/l). The 16 water samples showed a mean fluoride content of 2.90 + 0.93 mg/l.

Unraveling mystery: Role of fluoride in Sri Lanka CKDu epidemic

“…Nephrotoxicity of fluoride in animals and humans has been reported at higher exposure settings [14,15]. Dental fluorosis and skeletal fluorosis have been reported in humans exposed to fluoride levels similar to those of found in the present study [24,25]. Bone and the pineal gland are the major sites of fluoride accumulation in humans [16].…”

Correlation of fluoride intake to total bone mass at Asembagus, Situbondo, Indonesia

“…Most humans are subjected to fluoride through food and water consumption. The etiological factor of fluoride toxicity is the high fluoride levels in groundwater and then consumed that will accumulate as dental and skeletal fluorosis [6].…”

Fluoride and Pineal Gland

“…Significantly, the deposition of fluoride in hard tissues may have its own adverse effects. The symptoms of excessive fluoride accumulation in bones and teeth are known and well documented, classified as skeletal fluorosis and dental fluorosis, respectively [19][20][21][22][23][24]. In addition to deposition in hard tissues, fluoride may also be found in calcification areas in soft tissues such as the aorta [25][26][27][28][29], coronary arteries [30,31], placenta [32][33][34][35][36][37][38][39][40][41], tendons [42][43][44], or cartilage [42,45,46].…”