SKELETAL SCINTIGRAPHIC FINDINGS IN ENDEMIC SKELETAL FLUOROSIS

Endemic skeletal fluorosis is characterized by bone, joint and muscle pain, progressive ankylosis of various joints and crippling deformitie s. Whole body skeletal scintigraphy with Tc-99m-methylene diphosphonat e was performed for 17 symptomatic subjects suffering from this disord er. The fluoride content of drinking water ranged from 4.1 to 12.9 mg l-1 (normal <1 mg 1-1). Urinary and serum fluoride levels were markedl y elevated. Serum calcium (total and ionized), inorganic phosphorus, c reatinine and albumin were essentially normal while serum alkaline pho sphatase was elevated in six subjects (mean +/- S.D. 206 +/- 106; rang e 22-1072 IU l-1). Skeletal radiology revealed a wide spectrum of bony abnormalities. Skeletal scintigraphy revealed a picture similar to me tabolic 'superscan' in all subjects, i.e. increased tracer uptake in a xial and appendicular skeleton, reduced soft tissue uptake, poor or ab sent renal images, prominent costochondral junction and 'tie' sign in sternum. Increased uptake was present in all subjects irrespective of age, water fluoride content, serum alkaline phosphatase level and radi ological abnormalities. Our findings suggest the presence of a high bo ne turnover state in endemic skeletal fluorosis irrespective of other variables.