Table 2 –

Unusual Instances Of Skeletal Fluorosis

Ref no.	Author(s)	Year	Age/Sex	F-Source	Est.F-Daily Intake (mg)	Dur (yrs)	Clinical Presentation	Radiology Findings	Initial laboratory findings
									[F] Blood X ULN	[F] Urine X ULN	[F] Tissue High	ALP X ULN	PTH X ULN	25(OH)D ng/mL	cCa mg/dL	Cr mg/dL
27	Klemmer & Hadler	1978	27F	Inhaled anesthetic@			DBP, CRI, SC nodules	AOS, PD, bone scan uptake	130+	16+	Bone	4.3	1.6	13.4	9.8
35	Fisher et al#	1981	F	Soil		20	DBP, CRI	GOS			Bone
6	Whyte et al	2005	52F	tea	37–74	>30	Back pain and stiffness, joint pain, dental problems	AOS, LC, osteophytes		5.5		nl	nl	nl	nl	nl
23	Roos et al	2005	45F	toothpaste	66	>5	Pain, swelling of fingers, dental problems	PD, bone scan uptake	1.7	16		3.5	1.3	20.4	8.8
22	Hallanger et al	2007	50F	tea	56		DBP, CRI, kyphosis, smoker	GOS	4.8		Bone	17		12	9.9	2.1
			67F^	tea	13		Foot fracture, kyphosis, anorexia (BMI 15)	AOS	3.9			1.45	nl	19	9.7	1.3
			60F	tea + toothpaste	17		DBP, rib fractures, anorexia (BMI 17), smoker	AOS	2.6			nl	nl	54	9.8	1.5
			62F^	tea	14	30	Joint pain, CRI, high BMD (Screening DXA)	AOS, LC	4.3			nl	nl	25	9.9	1.7
16	Kurland et al	2007	52M	toothpaste			Stiff neck, joint pains	AOS, LC, SSO, bone scan uptake	1.7	24	Bone	1.8	nl	nl	nl	1.3
17	Little et al	2008	33M	Inhaled DFE			Fractures from motor vehicle accident	Exostoses, heterotopic bone
7	Whyte et al	2008	49F	tea	44	37	DBP, LE fracture	AOS, PD, LC, bone scan uptake	1.5	6.0	Nails	1.4	nl	42	9.1	1.1
8	Izuora et al	2011	48F	tea	19–37	30+	DBP, joint pain, kyphosis, smoker	GOS, LC, IOMC, SSO, STO, bone scan uptake	2.8	3.3	Nails	3.2	3.1	11	9.0	nl
21	Joshi et al	2011	53F	tea+ toothpaste	15		Foot fracture, dental problems, cerebral palsy	AOS, LC, SSO, profuse callus	17	10	Bone Nails	nl	nl	nl	nl
19	Kakamanu & Sudhaker	2013	47F	tea	>20	17	DBP, dental problems	AOS, IOMC	4.3
36	Rackoff et al	2015	70M	Inhaled Freon		2	LE nodules, heroin use, smoker	AOS, LC, SSO, STO, exostoses	49+					49	9.5	1.3
24	Tucci et al*	2017*	28M	Inhaled DFE		3–4	Hip ankylosis, kyphosis, femur fracture, UE bone deformities	GOS, PD, LC, IOMC, SSO, exostoses, focal osteopenia, bone scan uptake	2	5.9	Bone	1.8	nl	14	9.0
25	Peicher & Maalouf	2017	33M	Inhaled DFE		3	Back pain, loss of lumbar-lordosis	GOS	14			2.6	nl	32	9.6	0.94
28	Ponce et al	2019	27M	Inhaled DFE		1	UE & LE painless nodules, syncope, frostbite	PD, exostoses	3.8	16		5.2		10
	Our Patient	2020	51M	Inhaled DFE		2–3	DBP, fractures, obese, poor diet, opiate use, smoker	AOS, LC, IOMC, STO, osteophytes, soft tissue calcification, profuse callus, focal osteopenia, bone scan uptake	61	8.5		4.6	4.2	21	7.6	0.7

ALP = serum alkaline phosphatase, 25OHD = serum 25 hydroxy vitamin D, AN = anorexia nervosa, AOS = axial osteosclerosis, BMD = bone mineral density , BMI = body mass index, cCa = corrected serum calcium, Cr = serum creatinine, CRI = chronic renal insufficiency, DBP = diffuse bone pain, DFE = difluoroethane in computer duster, [F] = fluoride concentration, GOS = generalized osteosclerosis, IOMC = interosseous membrane calcification, LC = ligament calcifications or ossifications, LE = lower extremity, nl = reported as normal (lab values not provided), PD = periostitis deformans, PTH = serum intact parathyroid hormone, SC = subcutaneous, SSO = sacrospinous calcification or ossification, STO = sacrotuberous ligament calcification or ossification, UE = upper extremity, X ULN = times upper limit of normal

Blank boxes indicate this information was not available.

^#Abstract only available.

^*This case was reported also by Cohen et al (ref 26) in 2014 and by Tucci et al as an ASBMR abstract 2013

^{^}Follow up on these 2 cases was reported 11 years later (ref 20)

^@methoxyfluoroethane

⁺no normal range given so our assay normal range was used to estimate X ULN