Calcified Tissue International

, Volume 101, Issue 5, pp 545–548 | Cite as

Skeletal Fluorosis Due to Fluorocarbon Inhalation from an Air Dust Cleaner

Case Reports


Skeletal fluorosis (SF) is an osteosclerotic metabolic bone disorder caused by excessive ingestion or inhalation of fluoride. SF is extremely rare in developed countries. We report a case of SF due to inhalational abuse from a fluoride-containing air dust cleaner. A 33-year-old man with no past medical history presented with progressively worsening low back pain for 2 years. Physical examination was notable for loss of lumbar lordosis and tenderness over the lumbar spine. Radiographs were notable for uniform generalized osteosclerosis in the long bones, entire spine, rib cage, and pelvic bones, and loss of the normal lumbar curvature. DXA scan showed Z-scores of +10.7 at the lumbar spine, +6.5 at the total hip, and +1.0 at the 1/3 radius. Laboratory studies were notable for elevated serum alkaline phosphatase (334 U/L, ref: 40–129 U/L) compared to a normal value 3 years prior, suggesting acquired osteosclerosis. Serum fluoride concentration returned elevated (2.8 mg/L, ref: 0.0–0.2 mg/L). Initially, the source of fluoride excess could not be identified. At a follow-up visit, he was found inhaling from a can of an air duster hidden in an inner pocket. He admitted “huffing” 2–7 cans weekly from a fluorocarbon-containing air dust cleaner for the past 3 years to achieve a euphoric feeling, explaining the source of his SF. Fluoride inhalation can be a potential source for SF, and should be suspected in patients with acquired osteosclerosis, as inhalant abuse is increasingly practiced in many countries.


Fluorosis Fluoride Osteosclerosis Huffing Inhalational abuse 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The institutional review board waived the need for HIPAA consent.


  1. 1.
    Li Y, Liang C, Slemenda CW, Ji R, Sun S, Cao J, Emsley CL, Ma F, Wu Y, Ying P, Zhang Y, Gao S, Zhang W, Katz BP, Niu S, Cao S, Johnston CC (2001) Effect of long-term exposure to fluoride in drinking water on risks of bone fractures. J Bone Miner Res 16(5):932–939CrossRefPubMedGoogle Scholar
  2. 2.
    Perumal E, Paul V, Govindarajan V, Panneerselvam L (2013) A brief review on experimental fluorosis. Toxicol Lett 223(2):236–251CrossRefPubMedGoogle Scholar
  3. 3.
    Tucci JR, Whitford GM, McAlister WH, Novack D, Mumm S, Keaveny TM, Whyte MP (2016) Skeletal fluorosis due to inhalation abuse of a difluoroethane-containing computer cleaner. J Bone Miner Res 32(1):188–195. doi: 10.1002/jbmr.2923 CrossRefPubMedGoogle Scholar
  4. 4.
    Kurland ES, Schulman RC, Zerwekh JE, Reinus WR, Dempster DW, Whyte MP (2006) Recovery from skeletal fluorosis (an enigmatic, American case). J Bone Miner Res 22(1):163–170CrossRefGoogle Scholar
  5. 5.
    Whyte MP, Essmyer K, Gannon FH, Reinus WR (2005) Skeletal fluorosis and instant tea. Am J Med 118(1):78–82CrossRefPubMedGoogle Scholar
  6. 6.
    Nemeth L, Zsogon E (1989) Occupational skeletal fluorosis. Baillieres Clin Rheumatol 3(1):81–88CrossRefPubMedGoogle Scholar
  7. 7.
    Rackoff P (2015) Skeletal fluorosis—a tricky diagnosis. Arthritis Rheumatol 67(10):2701. doi: 10.1002/art.39237 CrossRefPubMedGoogle Scholar
  8. 8.
    Howard MO, Bowen SE, Garland EL, Perron BE, Vaughn MG (2011) Inhalant use and inhalant use disorders in the United States. Addict Sci Clin Pract 6(1):18–31PubMedPubMedCentralGoogle Scholar
  9. 9.
    Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S (2016) Youth risk behavior surveillance—United States, 2015. MMWR Surveill Summ 65(6):1–174. doi: 10.15585/mmwr.ss6506a1 CrossRefGoogle Scholar
  10. 10.
    MacLean S, Cameron J, Harney A, Lee NK (2012) Psychosocial therapeutic interventions for volatile substance use: a systematic review. Addiction 107(2):278–288CrossRefPubMedGoogle Scholar
  11. 11.
    Abdel-Gawad FA, Ashmawy MH, Zaki SM, Abdel-Fatah GH (2014) Lung damage after long-term exposure of adult rats to sodium fluoride. Arch Med Sci 10(5):1035–1040. doi: 10.5114/aoms.2014.46221 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Koroglu BK, Ersoy IH, Koroglu M, Balkarli A, Ersoy S, Varol S, Tamer MN (2011) Serum parathyroid hormone levels in chronic endemic fluorosis. Biol Trace Elem Res 143(1):79–86. doi: 10.1007/s12011-010-8847-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Teotia M, Teotia SP, Singh KP (1998) Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in India: year 2000. Indian J Pediatr 65(3):371–381CrossRefPubMedGoogle Scholar
  14. 14.
    Whyte MP, Totty WG, Lim VT, Whitford GM (2008) Skeletal fluorosis from instant tea. J Bone Miner Res 23(5):759–769. doi: 10.1359/jbmr.080101 CrossRefPubMedGoogle Scholar
  15. 15.
    Kakumanu N, Rao SD (2013) Images in clinical medicine. Skeletal fluorosis due to excessive tea drinking. N Engl J Med 368(12):1140. doi: 10.1056/NEJMicm1200995 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Endocrinology, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Division of Mineral Metabolism, Department of Internal of Medicine, and The Charles and Jane Pak Center for Mineral Metabolism and Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasUSA

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