SKELETAL FLUOROSIS DUE TO EXCESSIVE CONSUMPTION OF FLUORIDE-RICH BOTTLED WATER IN A PATIENT WITH MODERATELY SEVERE RENAL-FAILURE

A 71-year-old man with moderately severe renal failure who had been dr inking two liters per day of a fluoride-rich bottled water (Vichy Sain t-Yorre) for the last seven years developed arthralgia with radiologic al evidence of hyperostosis. Fluoride levels were elevated in the-seru m and urine. These criteria establish the diagnosis in 97% of cases of skeletal fluorosis, although the definitive test is determination of the level of fluoride in bone. The causes of fluoride intoxication are reviewed, and their clinical, laboratory test, and radiological featu res are discussed.