Incorrect Diagnosis
A 73-year old South Dakota man, who lived in an area with a known high high-fluoride content, visited his doctor complaining of urinary incontinence and nocturia. A physical examination revealed “moderate limitation in his right hip due to long-standing osteoarthritis.” X-rays revealed “widespread, increased density” of the ribs and “increased density” and calcification of the skull. An x-ray of the abdomen showed “widespread bony involvement of the lumbar spinal column and the pelvis,” with the bone displaying a “ground-glass appearance,” the lumbar spine showing “hypertrophic changes,” and the pelvis showing “bilateral calcification of the sacrospinous ligament.” Since the man also had an enlarged prostrate, doctors suspected “widespread bony metastasis.” The doctors then re-inspected x-rays they had taken of the patient 13 years previously, which “revealed a moderate increase in bone density confined to the lumbar spinal column and the pelvis.” Suspecting cancer, the authors tested tissue from the man’s prostrate, but it came back negative. The authors then concluded that “because of the long-standing bony changes and the history of excessive lifelong intake of water of high fluoride content,” the man had been suffering from skeletal fluorosis. Left unmentioned was the fact that the doctors failed to diagnose the condition for over 13 years–despite having x-ray evidence of increased bone density in the same pelvic area where the man suffered from “osteoarthritis.” SOURCE: Gilbaugh JH, Thompson GJ. (1966). Fluoride osteosclerosis simulating carcinoma of the prostate with widespread bony metastasis: a case report. Journal of Urology 96: 944-946.
