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Skeletal fluorosis due to excessive tea and toothpaste consumption
S Joshi1, T Hlaing, G M Whitford
1Clinical Biochemistry, Addenbrookes Hospital NHS Trust, Cambridge, UK. supriya.joshi@addenbrookes.nhs.uk
Summary
Excessive fluoride intake from tea and toothpaste can lead to fluorosis, causing unusually high bone mineral density (BMD) and fractures. This case highlights the importance of considering fluorosis in patients with unexpectedly high BMD.
Area of Science:
- Endocrinology
- Toxicology
- Orthopedics
Background:
- Bone mineral density (BMD) testing is crucial for diagnosing osteoporosis.
- Elevated BMD can indicate underlying metabolic or toxicological conditions.
Observation:
- A 53-year-old woman presented with a metatarsal fracture.
- She exhibited exceptionally high bone mineral density T-scores: +11 in the lumbar spine and +7.6 in the hip.
Findings:
- Investigations revealed significantly elevated fluoride levels in serum, urine, and tissues.
- Excessive consumption of tea and toothpaste was identified as the likely source of fluoride overload.
Implications:
- This case underscores the necessity of screening for fluorosis in individuals presenting with unusually high BMD.
- High fluoride levels can paradoxically lead to bone fragility and fractures, despite high bone density.
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