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Year : 2011  |  Volume : 134  |  Issue : 2  |  Page : 242-243

Endemic skeletal fluorosis

Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India

Date of Web Publication10-Sep-2011

Correspondence Address:
P P Kotwal
Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Kotwal P P. Endemic skeletal fluorosis. Indian J Med Res 2011;134:242-3

How to cite this URL:
Kotwal P P. Endemic skeletal fluorosis. Indian J Med Res [serial online] 2011 [cited 2020 May 31];134:242-3. Available from:

D. Raja Reddy, S. R. Deme, editors (Ramaiah Vidyapeetham, Hyderabad) 2010. 171 pages. Price: 250.00

Fluorosis is prevalent in many parts of India and is responsible for backache and crippling disorders. This book gives an exhaustive account of the various aspects of this disorder.

The Introduction covers the historical aspect of the disease, its prevalence in world and particularly in India. The authors seem to have done extensive literature search and have reported the occurrence of the disease in each country with the relevant references. It is interesting to note that conferences have also been organized on Fluorosis, in India. This chapter also gives a map of the world and that of India depicting the sites and incidence of the disease. The chapter on Metabolism of fluoride provides the information on metabolism of fluoride giving a detailed account of the sources of fluoride in water, food and air. Various foot stuff containing fluoride are depicted in a tabular form. The Table also gives the fluoride content in water not only in India but in many other countries of the world. This chapter also gives a detailed account of distribution and excretion of the fluoride in the body.

Chapter 3 contains a detailed account of the epidemiological studies on fluoride. The following have been reported to play a significant role in the causation of endemic skeletal fluorosis: Weather, Occupation, Kidney function, and Nutrition. The epidemiological studies were conducted in detail in some districts of Andhra Pradesh.

Chapter 4 gives a detailed account of the clinical features of fluorosis. The remarkable aspect is the correlation of the dose of fluoride with the organ affected in the body. For example, the water content of 1 ppm causes dental carries reduction, 2 ppm causes dental fluorosis, 50 ppm in water or food causes thyroid changes and 125 ppm can cause kidney changes. The clinical features have been described for skeletal fluorosis, neurological manifestation and also in non-skeletal organs. A large number of photographs support the clinical picture.

Chapter 5 gives an elaborate description of the laboratory investigations in fluorosis which include urine estimation, electrophysiological studies, bone biopsy, pulmonary function tests and scintigraphic studies. The authors have also given an extensive description of X-ray changes in fluorosis in long bones, spine and pelvis supported by numerous figures. CT and MRI findings are also discussed in detail. The chapter 6 covers up the pathology of fluorosis. The aspects discussed meticulously include gross changes in the skeleton, and histopathology of bones, muscles, nerves and spinal cord. Each of these aspects is supported by relevant photographs. Differential diagnosis of fluorosis is discussed in chapter 7.

Chapter 8 discusses the optimum water fluoride concentration and fluoridation controversy. The WHO guidelines of water fluoride content are discussed in this chapter.

The prevention and treatment of skeletal fluorosis is discussed in chapter 9 at length. It also gives an account of preferred foods in the fluorotive regions. The observations/recommendations are supported by an exhaustive bibliography.

Overall, this can be a very good reference book on fluorosis which can interest epidemiologist, researcher and clinician alike. The authors can be complemented for the extensive literature search and good compilation of the data and pictures.


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