Skeletal fluorosis, even in its most advanced crippling phase, can be easily misdiagnosed as another type of bone disease.
There are four factors that explain this failure:
The first factor is that symptoms of joint pain and stiffness can precede the development of detectable bone changes. This “pre-skeletal” phase of the disease is extremely difficult to diagnose, as the symptoms are “non-specific” and indistinguishable from the joint pains of common arthritic conditions.
The second factor is that, even when bone changes do occur, they may not look like the classic form of skeletal fluorosis, with “axial osteosclerosis” (increased density of the spine, pelvis, and ribs). Some fluorosis patients may experience osteophytes (bone spurs) and interosseous membrane calcification (calcification tendons and ligaments) in the peripheral skeleton.
The third factor even when the bone changes typical of classical fluorosis are present, they can mimic the appearance of other diseases, including osteoarthritis, spondylosis, DISH, Paget’s Disease, and bony metastasis. As noted by a team of American doctors who treated a woman with crippling skeletal fluorosis: “Our case report illustrates dramatically that fluorosis can lead to severe disability while closely mimicking a wide variety of other disorders… We believe increased awareness of this unusual disease is needed to enable physicians to make the proper diagnosis.”
The fourth factor explaining the frequency of misdiagnosis, is that current medical understanding of skeletal fluorosis has been shaped by longstanding, but now scientifically discredited, notions that the levels of fluoride necessary to produce fluorosis are uniform across the population and far higher than the vast majority of individuals in western populations ever receive. In other words, the doses that many American adults routinely ingest (average 6.6 mg of fluoride per day) overlap the doses that modern research indicates can cause arthritic symptoms and the early stages of skeletal fluorosis.
As a result of these four factors, there’s a certainty that individuals in the general population who have some form of skeletal fluorosis, are being misdiagnosed as suffering from commonly known conditions (e.g.osteoarthritis). The failure to identify fluoride as the cause of the disease, results in years of ineffective treatments and unnecessary pain. The only known way to alleviate the symptoms of fluorosis is to identify, and discontinue the source of fluoride causing the problem. (Hallanger-Johnson 2007)