Kudo H
Department of Hygiene and Public Health, School of Medicine, Iwate Medical University.
Nihon Eiseigaku Zasshi. 1991 Dec;46(5):984-93. doi: 10.1265/jjh.46.984.
The clinical manifestations of osteofluorosis in subjects exposed to high levels of fluoride in air or drinking water for longer than 10 years were observed. In particular, the relationship among the findings observed in X-ray pictures of bone and the extent of fluoride exposure, and the concentrations of fluoride in serum, urine and the environment were studied. Interpretation of the film was carried out by orthopedic surgeons by means of blind tests. When sclerotic changes of bone at more than two locations were observed, the subject was diagnosed as having possible osteofluorosis. From these studies, the following conclusions were obtained. 1) Of the 63 subjects exposed to airborne fluoride (average concentration: 0.88 +/- 0.74mg/m3; max.: 2.9mg/m3) for longer than 10 years, four possible cases of osteofluorosis were found. However, there were no patients presenting typical osteofluorosis. The average fluoride concentrations in serum and urine of the exposed group were 0.055 +/- 0.045ppm and 2.99 +/- 2.20ppm, respectively. The values were almost twice as high as those found in the control group (47 subjects). 2) Of the 95 residents in areas where the concentration of fluoride in drinking water was high (area A: 1.0-3.2 ppm and area B: 2.0-13 ppm), 19 subjects were diagnosed as possible cases of osteofluorosis and one case of definite osteofluorosis (corresponding to the second phase of the Roholm's classification) was found. In the latter case, the subject had drunk highly contaminated (12ppm) water for 26 years; a high serum fluoride concentrations (0.427ppm) and high levels of ALP and osteocalcin were found. This is one of the rare cases of osteofluorosis in Japan; only a few cases have been reported in the past. 3) As primary signs of changes in bone due to osteofluorosis, as seen in X-ray pictures, osteophytes of the lumbar vertebrae, ossification of the pelvic obturator membrane and ligaments and ossification of the interosseous membranes of forearms and lower legs are emphasized.
观察了长期（超过10年）暴露于空气中或饮用水中高氟环境的人群氟骨症的临床表现。特别研究了骨X线片所见结果与氟暴露程度以及血清、尿液和环境中氟浓度之间的关系。由骨科医生通过盲法对X线片进行解读。当观察到两个以上部位出现骨硬化改变时，该受试者被诊断为可能患有氟骨症。从这些研究中得出了以下结论。1）在63名长期（超过10年）暴露于空气中氟化物（平均浓度：0.88±0.74mg/m³；最高：2.9mg/m³）的受试者中，发现了4例可能患有氟骨症的病例。然而，没有出现典型氟骨症的患者。暴露组血清和尿液中的平均氟浓度分别为0.055±0.045ppm和2.99±2.20ppm。这些值几乎是对照组（47名受试者）的两倍。2）在饮用水氟浓度较高的地区（A区：1.0 - 3.2ppm，B区：2.0 - 13ppm）的95名居民中，19名受试者被诊断为可能患有氟骨症，发现了1例确诊的氟骨症（对应于Roholm分类的第二阶段）。在后一种情况下，该受试者饮用高污染（12ppm）水达26年；发现其血清氟浓度高（0.427ppm）以及碱性磷酸酶和骨钙素水平高。这是日本罕见的氟骨症病例之一；过去仅报道过少数病例。3）如X线片所示，作为氟骨症导致的骨改变的主要征象，腰椎骨赘、骨盆闭孔膜和韧带骨化以及前臂和小腿骨间膜骨化较为突出。
