Abstract | BACKGROUND: There is scant data available on the pathogenetic mechanisms of varied clinical presentation of bone disease in patients with excess fluoride ingestion in the Indian subcontinent. The present study is comprehensive and state of the art, incorporating all essential elements of bone mineral metabolism in patients with excess fluoride ingestion. METHODS: FINDINGS: Major clinical manifestations were bone pain (79%), Tetany (12.5%) and dental mottling (38%). Radiological findings included osteosclerosis (96%), pseudofracture and ligamentous calcification (50%). These patients manifested hypocalcemia and raised SAP with normal serum phosphorus. There was a positive correlation between serum creatinine and phosphorous excretion index (PEI) and a negative correlation between declining endogenous creatinine clearance (Cr.Cl) and increasing renal loss of calcium and phosphorus as indicated by increased calcium to creatinine ratio and PEI. Bone histomorphometry revealed impairment of primary mineralization with hypomineralized lacunae, interstitial mineralization defects and very thick and extended osteoid seams. Autopsy findings in a patient who died of azotemia showed tubular atrophy with secondary glomerular changes. INTERPRETATION:
Fluoride intoxication plays an important role in the pathogenesis of the unique osteo-renal syndrome.
|
Authors | C V Harinarayan, N Kochupillai, S V Madhu, N Gupta, P J Meunier |
Journal | Bone
(Bone)
Vol. 39
Issue 4
Pg. 907-14
(Oct 2006)
ISSN: 8756-3282 [Print] United States |
PMID | 16781206
(Publication Type: Journal Article)
|
Chemical References |
- Parathyroid Hormone
- Vitamin D
- Phosphorus
- 25-hydroxyvitamin D
- Creatinine
- Alkaline Phosphatase
- Fluorides
- Calcium
|
Topics |
- Adolescent
- Adult
- Alkaline Phosphatase
(blood)
- Bone Diseases, Metabolic
(blood, chemically induced, pathology)
- Bone and Bones
(diagnostic imaging, drug effects, pathology)
- Calcium
(blood)
- Creatinine
(blood)
- Fluorides
(administration & dosage)
- Humans
- India
- Kidney
(diagnostic imaging, drug effects, pathology)
- Kidney Diseases
(blood, chemically induced, pathology)
- Middle Aged
- Parathyroid Hormone
(blood)
- Phosphorus
(blood)
- Radiography
- Syndrome
- Vitamin D
(analogs & derivatives, blood)
|