Fluorosis¶

Overview¶

Chronic excessive fluoride intake causes diffuse osteosclerosis and ligamentous calcification. In the spine, it produces diffuse dense sclerosis of the vertebral bodies, calcification of spinal ligaments (ALL, PLL, ligamentum flavum), and spinal canal narrowing. Endemic in areas with high fluoride in drinking water (India, China).

Key Imaging Distinction¶

Fluorosis calcifies ligaments AND produces dense vertebral sclerosis. DISH calcifies the ALL but does NOT cause vertebral body sclerosis. AS produces syndesmophytes, not ligament calcification. Fluorosis is denser and more uniform than either.

Key Points¶

• Diffuse vertebral sclerosis with ligament calcification
• Endemic in high-fluoride water regions
• Spinal canal narrowing from ligament ossification can cause myelopathy
• Distinguish from DISH (no vertebral sclerosis) and AS (syndesmophytes, sacroiliac fusion)

References¶

1. Wang Y, Yin Y, Gilula LA, Wilson AJ. Endemic fluorosis of the skeleton: radiographic features in 127 patients. AJR Am J Roentgenol. 1994;162(1):93-98. https://pubmed.ncbi.nlm.nih.gov/8273699/
2. Sellami M, Riahi H, Maatallah K, Ferjani H, Chelli Bouaziz M, Ladeb MF. Skeletal fluorosis: don't miss the diagnosis! Skeletal Radiol. 2020;49(3):345-357. https://pubmed.ncbi.nlm.nih.gov/31501957/
3. Ahmed I, Sohail S, Hussain M, Khan N, Khan MH. MRI features of spinal Fluorosis: Results of an endemic community screening. Pak J Med Sci. 2013;29(1):177-180. https://pubmed.ncbi.nlm.nih.gov/24353535/
4. Srivastava S, Flora SJS. Fluoride in Drinking Water and Skeletal Fluorosis: a Review of the Global Impact. Curr Environ Health Rep. 2020;7(2):140-146. https://pubmed.ncbi.nlm.nih.gov/32207100/
5. Skeletal fluorosis. Radiopaedia.org. https://radiopaedia.org/cases/skeletal-fluorosis-1

Related Articles¶

• DISH
• Ankylosing Spondylitis