Calcified Tissue Research

, Volume 16, Issue 1, pp 45–57 | Cite as

Histopathological assessment of endemic skeletal fluorosis

  • J. M. Faccini
  • S. P. S. Teotia
Original Papers


Nine patients with skeletal fluorosis were subjected to iliac crest biopsy because they presented with stiffness and bone pains. The histopathological findings are correlated with the clinical course, X-ray and laboratory data. All but one of the patients showed an increase in bone surfaces lined by osteoid and in these eight patients resorption of bone was the most striking finding and in one case the bone marrow was predominantly fibrous. The severity of radiological and histological bone changes appeared to increase with the duration of exposure to fluoride water in the majority of the cases. The increase in resorption surfaces correlated, positively, with plasma levels of alkaline phosphatase, bone fluoride and the radiological findings of coarse striated patterns and erosions in the bone. The histopathological picture had no relationship with the plasma calcium and the urinary excretions of calcium and fluoride. The concentration of fluoride in the iliac crest biopsies was related to the degree of bone resorption in majority of the cases and the highest level in these patients was in the one who had stayed longer in the endemic fluorosis area. New bone formation and osteoclastic resorption were probably caused by the increased action of parathyroid hormone secondary to the fluorosis. The hyperfunction of the parathyroid glands developed as a compensatory phenomenon to maintain the plasma calcium in the presence of the fluoroapatite crystals which are known to be less soluble and less reactive.

Key words

Pathology Fluorosis Histology 


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  1. Bernstein, D., Cohen, P.: Use of sodium fluoride in the treatment of osteoporosis. J. clin. Endocr.27, 197–210 (1967)PubMedGoogle Scholar
  2. Bordier, P., Matrajt, H., Hioco, D., Hepner, G. W., Thompson, G. R., Booth, C. C.: Subclinical vitamin D deficiency following gastric surgery. Histological evidence in bone. Lancet1968 I, 437–440.Google Scholar
  3. Faccini, J. M.: Inhibition of bone resorption in the rabbit by fluoride. Nature (Lond.)214, 1269–1271 (1967)Google Scholar
  4. Faccini, J. M.: Fluoride and bone. — A review. Calc. Tiss. Res.3, 1–16 (1969)Google Scholar
  5. Faccini, J. M., Care, A. D.: The effect of fluoride on the ultrastructure of the parathyroid glands of the sheep. Nature (Lond.)207, 1399–1401 (1965)Google Scholar
  6. Fiske, C. H., Subbarow, Y.: The colorimetric determination of phosphorus. J. biol. Chem.66, 375–400 (1925)Google Scholar
  7. Geever, E. F., Leone, N. C., Geiser, M. S., Leibman, J. E.: Pathological studies in man after prolonged ingestion of fluoride in drinking water. Publ. Hlth Rep. (Wash.)73, 721–731 (1950)Google Scholar
  8. Jolly, S. S.: Hydric fluorosis in Panjab (India). Fluoride in medicine (ed. T. L. Vischer). Bern: Hans Huber 1970Google Scholar
  9. Jowsey, J., Riggs, B. L., Kelly, P. J., Hoffman, D. L.: Effect of combined therapy with sodium fluoride vitamin D and calcium in osteoporosis. Amer. J. Med.53, 43–49 (1972)CrossRefPubMedGoogle Scholar
  10. King, E. J., Armstrong, A. R.: A convenient method for determining serum and bile phosphate activity. Canad. med. Ass. J.31, 376–381 (1934)Google Scholar
  11. Loevenhart, A. S., Peirce, G.: The inhibiting effect of sodium fluoride on the action of lipase. J. biol. Chem.2, 387–403 (1906)Google Scholar
  12. Matrajt, M., Hioco, D.: Solochrome cyamine R as an indicator dye of bone morphology. Stain Technol.41, 97–100 (1966)PubMedGoogle Scholar
  13. Matrajt, M., Bordier, P., Hioco, D.: Mesures histologiques semi-quantitatives dans 17 observations d'osteomalacies nutritionelles et renales. Influence de la vitamine D. L[Osteomalacie (ed. D. J. Hioco), p. 101–115. Paris: Masson & Cie. 1967Google Scholar
  14. Melvin, K. E. W., Hepner, G. W., Bordier, P., Neale, G., Joplin, G. F.: Calcium metabolism and bone pathology in adult coeliac disease. Quart. J. Med., N.S.153, 83–113 (1970)Google Scholar
  15. Nichols, G., Jr., Flanagan, B., Woods, J. F.: In the parathyroid glands: ultrastructure, secretion and function (eds. P. J. Gaillard, R. V. Talmage), p. 243. Univ. Chicago Press 1965Google Scholar
  16. Pandit, C. E., Raghavachari, T. N. S., Rao, D. S., Krishnamurti, V.: Endemic fluorosis in South India. Study of factors involved in production of mottled enamel in children and severe bone manifestation in adults. Indian J. med. Res.28, 533–558 (1940)Google Scholar
  17. Posner, A. S., Eaves, E. D., Harper, R. A., Zipkin, I.: X-ray diffraction of fluoride on human bone apatite. Arch. oral Biol.8, 549–556 (1963)CrossRefGoogle Scholar
  18. Ramberg, C. F., Jr., Phang, J. M., Mayer, G. P.: Inhibition of calcium absorption and elevation of calcium removal rate from bone in fluoride-treated calves. J. Nutr.100, 981–989 (1970)PubMedGoogle Scholar
  19. Roholm, K.: Fluoride intoxication. A clinical hygienic study with a review of the literature and some experimental investigations. London: H. K. Lewis & Co. 1937Google Scholar
  20. Sankeran, B., Gadekar, N. G.: Bone and tooth (ed. H. J. J. Blackwood), p. 357. Oxford: Pergamon Press 1964Google Scholar
  21. Schenk, R. K., Merz, W. A., Muller, J.: A quantitative histological study on bone resorption in human cancellous bone. Acta anat. (Basel)74, 44–53 (1969)Google Scholar
  22. Singer, L., Armstrong, W. D.: Determination of fluoride. Procedure based on diffusion of hydrogen fluoride. Anal. Biochem.10, 495–500 (1965)Google Scholar
  23. Singh, A., Jolly, S. S., Bansal, B. C., Mathur, C. C.: Endemic fluorosis. Epidemiological clinical and biochemical study of fluorine intoxication in Punjab (India). Medicine (Baltimore)42, 142–152 (1963)Google Scholar
  24. Teotia, S. P. S.: Endemic skeletal fluorosis. Arch. Dis. Child.46, 686–691 (1971)PubMedGoogle Scholar
  25. Teotia, S. P. S., Teotia, M.: Endemic skeletal fluorosis in children. Evidence of secondary hyperparathyroidism. Abstracts: International symposium on clinical aspects of metabolic bone disease. Henry Ford Hospital Michigan 26–29 (1972)Google Scholar
  26. Teotia, S. P. S., Teotia, M.: Secondary hyperparathyroidism in patients with endemic skeletal fluorosis. Brit. med. J.1973 I, 637–640Google Scholar
  27. Whitby, L. G., Lang, D.: Experience with the chromic oxide method of fecal marking in metabolic balance investigations on humans. J. clin. Invest.39, 854–863 (1960)PubMedGoogle Scholar
  28. Woods, C. G., Morgan, D. B., Paterson, C. R., Grossmann, H. H.: Measurement of osteoid in bone biopsy. J. Path. Bact.95, 441–447 (1968)PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1974

Authors and Affiliations

  • J. M. Faccini
    • 1
  • S. P. S. Teotia
    • 2
  1. 1.Medical SchoolUniversity College HospitalLondonUK
  2. 2.Department of Human MetabolismL.L.R.M. Medical CollegeMeerutIndia

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