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Total hip arthroplasty for diffuse skeletal fluorosis
Tony Chang1,2, Kathryn J Steven3, Gregory Charville4
1School of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
BMJ Case Reports
|October 9, 2025
Summary
This case study details a woman diagnosed with diffuse skeletal fluorosis due to chronic inhalant abuse. Early symptoms mimicked other bone disorders, highlighting diagnostic challenges in complex medical histories.
Area of Science:
- Orthopaedic Surgery
- Radiology
- Toxicology
Background:
- A woman in her late 50s with prior orthopaedic surgeries presented with severe hip pain.
- Initial radiographs showed diffuse bone sclerosis, suggesting Paget's disease or metabolic bone disorders.
Purpose of the Study:
- To report a case of diffuse skeletal fluorosis secondary to inhalant abuse.
- To emphasize diagnostic challenges in patients with complex medical histories and potential substance abuse.
Main Methods:
- Radiographic and advanced imaging (e.g., CT, MRI) were used for skeletal assessment.
- Patient history, including chronic inhalant abuse (computer duster), was crucial for diagnosis.
- Pathological examination of the femoral head after total hip arthroplasty was performed.
Main Results:
- Widespread skeletal sclerosis and cortical thickening were observed throughout the axial skeleton.
- Diagnosis of diffuse skeletal fluorosis was established, linked to difluoroethane exposure from inhalant abuse.
- Pathology confirmed osteosclerotic bone disease with enlarged, irregular trabeculae and high osteoclastic activity.
Conclusions:
- Diffuse skeletal fluorosis can present with symptoms mimicking other bone diseases, complicating diagnosis.
- Inhalant abuse, particularly with computer dusters, is a potential cause of severe skeletal pathology.
- Comprehensive patient evaluation and awareness of environmental/substance exposures are vital for accurate diagnosis and management.
