The high prevalence of osteoarthritis in Australia and other fluoridating communities
According to the Australian Institute of Health and Welfare, “Osteoarthritis is a chronic and progressive condition that mostly affects the hands, spine and joints such as hips, knees and ankles. It is the most common form of arthritis and the predominant condition leading to knee and hip replacement surgery in Australia.” More details available here.
Osteoarthritis (OA) has also been referred to as a disease characterised by a progressively debilitating stiffness and pain in the joints, resulting from degeneration in the joint cartilage, degeneration in the bone tissue underlying the joints and bony overgrowth.
In 2011, the US Centres for Disease Control (CDC) estimated that more than 27 million Americans have osteoarthritis (OA). In fact OA is the number one cause of disability in the US.
In July 2018, Arthritis Australia stated that:
- 1 in 5 Australians aged over 45 have osteoarthritis;
- 1 in 5 Australians (21%) over the age of 45 have osteoarthritis.
- OA is most common in adults aged 80 years and older, with just over one-third (35%) of people in this age group reporting the condition
More details from Arthritis Australia are available here.
Osteoarthritis and fluoride
Numerous studies have shown that skeletal fluorosis (a bone disease caused by too much fluoride) can cause symptoms and degenerative changes closely resembling osteoarthritis. While these arthritic effects were once considered to be confined to those with skeletal fluorosis, recent research shows that fluoride can cause osteoarthritis in the absence of traditionally defined fluorosis.
If conventional methods for detecting skeletal fluorosis continue to be used, many individuals with fluoride-induced osteoarthritis will not receive the correct diagnosis and treatment.
Symptoms are often mimicked
The symptoms of skeletal fluorosis (chronic joint pain and stiffness) mimic the symptoms of osteoarthritis. As an example of this, the following figure displays the findings from a recent Chinese study that investigated the prevalence of osteoarthritic symptoms in populations based on the level of fluoride in the drinking water:
Fluoride can cause osteoarthritis
Various studies have shown that skeletal fluorosis can not only produce bone changes that resemble osteoarthritis, it can cause osteoarthritis itself. (Luo 2012; Su 2012; Bao 2003; Savas 2001; Tartatovskaya 1995; Chen 1988; Xu 1987).
In 2003, a Chinese research group lead by Wensheng Bao et al, convincingly demonstrated in a well-conducted study. The researchers x-rayed the right hand of adults living in a fluorosis area. They then compared these x-rays with the findings of a nearby non-fluorosis area and the findings of a nationwide study that they had previously conducted. The incidence of osteoarthritis in the fluorosis area was “remarkably higher” than in either the adjacent area or the nation as a whole. According to the researchers, “the osteoarthritis caused by fluorosis differs from ordinary osteoarthritis in severity rather than in nature.”
Fluoride and osteoarthritis – before skeletal fluorosis is evident
For years, US and Australian health authorities have assumed that fluoride does not cause arthritic symptoms before the traditional bone changes of fluorosis are evident on x-ray. Several studies strongly suggests that this long-held assumption is in error.
Savas (2001): This Turkish study found strong evidence of a fluoride-osteoarthritis link in individuals who did not have telltale sign of skeletal fluorosis. The most common radiological finding among the fluorosis patients was knee osteoarthritis — which was found in 66% of the 56 fluorosis patients examined.
Tartatovskaya (1995): This team of Russian researchers found that fluoride-exposed individuals suffer a significantly elevated rate of osteoarthritis in the absence of radiologically detectable fluorosis in the spine.
Czerwinski (1988): Consistent with the Turkish and Russian studies, a team of Polish researchers examined 2,258 fluoride-exposed workers in the aluminum industry and found high rates of arthritic effects in the absence of fluorosis bone changes. Although the researchers could only detect fluorosis by x-ray in 1% of the workers, they found high rates of joint pain in the knee, hip, elbow, shoulder and lumbar spine, with the pains correlating to the duration of fluoride exposure.
Cao (2003): Chinese researchers found that 5 of 19 patients with crippling skeletal fluorosis “presented with mainly articular injury but relatively mild bone pathology.” The researchers termed this condition “fluorosis arthropathy.”
More details of these studies are available here.
Common misdiagnosis
As fluoride can cause OA in the joints prior to, and in the absence of, detectable osteosclerosis in the spine, skeletal fluorosis is difficult to diagnose. Many doctors are simply not trained to recognise fluoride-induced osteoarthritis (“secondary osteoarthritis”) and therefore many cases will be misdiagnosed as “primary osteoarthritis,” thus depriving patients of the most effective treatment for the condition (reduction in fluoride exposure).
In 1995, Roschger and his team of Austrian researchers highlighted the difficulty of differentiating between osteoarthritis and early stage skeletal fluorosis. In this study, the doctors conducted x-rays of a woman who received high-dose fluoride treatment for six years as an experimental treatment for osteoporosis. After the woman sustained multiple spontaneous fractures, the doctors x-rayed her skeleton and measured her bone density. The“radiographs of the skeleton and bone scintigraphy showed degenerative osteoarthritis,” but none of the traditional signs of skeletal fluorosis. It wasn’t until the doctors performed a bone biopsy that the doctors were able to detect the presence of fluorosis. As the doctors noted, “Without bone biopsy we would have failed the correct diagnosis.” Based on this experience, the doctors concluded that “invasive investigation of the skeleton (bone biopsy, histomorphometry, BSEI plus SAXS) is the only diagnostic tool, when skeletal fluorosis is suspected.”
References
- Bao W, et al. (2003). Report of investigations on adult hand osteoarthritis in Fengjiabao Village, Asuo Village, and Qiancheng Village. Chinese Journal of Endemiology 22(6):517-18. Available here.
- Cao J, et al. (2003). Brick tea fluoride as a main source of adult fluorosis. Food and Chemical Toxicology 41(4):535-42.
- CDC (2011). Osteoarthritis. Available here.
- Chen X. (1988): Radiological Analysis of Fluorotic Elbow Arthritis. Journal of Guiyang Medical College 13(2):303-305. Available here.
- Czerwinski E, et al. (1988). Bone and joint pathology in fluoride-exposed workers. Archives of Environmental Health 43(5):340-3. Abstract available here.
- Ge X, et al. (2006). Investigations on the occurrence of osteoarthritis in middle-aged and elderly persons in fluorosis-afflicted regions of Gaomi City with high fluoride concentration in drinking water. Preventive Medicine Tribune 12(1):57-58. Available here.
- Luo R, et al. (2012). Total knee arthroplasty for the treatment of knee osteoarthritis caused by endemic skeletal fluorosis. Chinese Journal of Tissue Engineering Research. Available here.
- Petrone P, et al. (2011). Enduring Fluoride Health Hazard for the Vesuvius Area Population: The Case of AD 79 Herculaneum. PLoS ONE 6(6): e21085. Available here.
- Tartatovskaya LY, et al. (1995). Clinical and hygiene assessment of the combined effect on the body of vibration and fluorine. Noise and Vibration Bulletin 263-264. Abstract available here.
- Roschger P, et al. (1995). Bone mineral structure after six years fluoride treatment investigated by backscattered electron imaging (BSEI) and small angle x-ray scattering (SAXS): a case report. Abstract available here.
- Savas S, et al. (2001). Endemic fluorosis in Turkish patients: relationship with knee osteoarthritis. Rheumatology International 21(1):30-5. Abstract available here.
- Su WM, et al. (2012). Total hip arthroplasty for the treatment of severe hip osteoarthritis due to fluorosis. Chinese Journal of Tissue Engineering Research 16(9):1543-1546. Available here.
- Xu JC, et al. (1987). X-ray findings and pathological basis of bone fluorosis. Chinese Medical Journal 100:8-16. Available here.