Mapping of fluoride endemic areas and assessment of fluoride exposure

The prevalence of fluorosis is mainly due to the consumption of more fluoride through drinking water. It is necessary to find out the fluoride endemic areas to adopt remedial measures to the people on the risk of fluorosis. The objectives of this study are to estimate the fluoride exposure through drinking water from people of different age group and to elucidate the fluoride endemic areas through mapping. Assessment of fluoride exposure was achieved through the estimation fluoride level in drinking water using fluoride ion selective electrode method. Google earth and isopleth technique were used for mapping of fluoride endemic areas. From the study it was observed that Nilakottai block of Dindigul district in Tamil Nadu is highly fluoride endemic. About 88% of the villages in this block have fluoride level more than the prescribed permissible limit in drinking water. Exposure of fluoride among different age groups was calculated in this block, which comprises 32 villages. The maximum estimated exposure doses were 0.19 mg/kg/day for infants, 0.17 mg/kg/day for children and 0.10 mg/kg/day for adults. When compared with adequate intake of minimal safe level exposure dose of 0.01 mg/kg/day for infants and 0.05 mg/kg/day for other age groups, a health risk due to fluorosis to the people in Nilakottai block has become evident. From the results, the people in Nilakottai block are advised to consume drinking water with fluoride level less than 1 mg/l. It has been recommended to the government authorities to take serious steps to supply drinking water with low fluoride concern for the fluorosis affected villages.     

Determining the optimal fluoride concentration in drinking water for fluoride endemic regions in South India

Fluoride ion in drinking water is known for both beneficial and detrimental effects on health. The prevalence of fluorosis is mainly due to the intake of large quantities of fluoride through drinking water owing to more than 90% bioavailability. The objective of this study is to predict optimal fluoride level in drinking water for fluoride endemic regions by comprising the levels of fluoride and other water quality parameters in drinking water, prevalence of fluorosis, fluoride intake through water, food and beverages such as tea and coffee and also considering the progressive accumulation of fluoride in animal bones, by comparing with non fluoride endemic areas comprise of the same geological features with the aid of regression analysis. Result of this study shows that increase of fluoride level above 1.33 mg/l in drinking water increases the community fluorosis index (CFI) value more than 0.6, an optimum index value above which fluorosis is considered to be a public health problem. Regression plot between water fluoride and bone fluoride levels indicates that, every increase of 0.5 mg/l unit of water fluoride level increases the bone fluoride level of 52 mg/kg unit within 2 to 3 years. Furthermore, the consumption of drinking water containing more than 0.65 mg/l of fluoride can raise the total fluoride intake per day more than 4 mg, which is the optimum fluoride dose level recommended for adults by the Agency for Toxic Substances and Disease Registry. From the result, the people in fluoride endemic areas in South India are advised to consume drinking water with fluoride level within the limit of 0.5 to 0.65 mg/l to avoid further fluorosis risk.     

Screening high-fluoride and high-arsenic drinking waters and surveying endemic fluorosis and arsenism in Shaanxi province in western China

The objectives of this study were to screen high-fluoride and high-arsenic drinking waters, to evaluate the effectiveness of fluoride-reducing projects and to assess the present condition of endemic fluorosis and arsenism in Shaanxi province in western China. For screening high-fluoride drinking waters, five water samples were collected from each selected village where dental fluorosis patients were detected in 8-12 year-old children. For evaluating the effectiveness of fluoride-reducing projects, four water samples were collected from each project at end-user level. Fluoride concentrations in water samples were measured by fluoride-selective electrode method or spectrophotometry. Dental fluorosis in children aging 8-12 years was examined according to Horowitz's Tooth Surface Index of Fluorosis. Skeletal fluorosis in adults was detected clinically and radiologically according to Chinese Criteria of Clinical Diagnosis of Skeletal Fluorosis. For screening high-arsenic waters, 20 water samples were collected from each village which was selected from areas characterized by the geographic features to induce high-arsenic underground water, i.e., alluvial plains, ore mining or smelting areas, geothermal artesians, and thermal springs. Arsenic concentrations in water samples were determined by spectrophotometry or arsine generation atomic fluorospectrophotometry. Arsenism in adults aging 40-89 years was examined in villages with arsenic concentrations in drinking water above 0.05 mg/l according to Chinese Criteria for Classification of Endemic Arsenism Areas and Clinical Diagnoses of Endemic Arsenism. The results showed that the fluoride level of 7144 water samples was 1.17 +/- 0.93 mg/l. There were 3396 (47.6%) high-fluoride waters (fluoride level was above 1.0 mg/l) distributing in 786 (45.1%) villages, where about 0.8 million (50.0%) people inhabited. Additionally, the 1315 fluoride-reducing projects were studied. The fluoride level of the projects was 2.79 +/- 1.09 and 0.98 +/- 0.47 mg/l before and after building the projects, which remained at relatively lower level (1.03 +/- 0.47 mg/l). But there were still 58.0% of the projects providing drinking waters with fluoride concentrations beyond 1.0mg/l. The rates of dental fluorosis and skeletal fluorosis were 38.2% and 11.8%, respectively. The arsenic level of 1732 water samples was 0.010 +/- 0.082 mg/l. There were 174 (14.9%) high-arsenic waters (arsenic level was above 0.010 mg/l) being detected, distributing in 41 (38.7%) villages. The arsenic level in 53 (4.5%) water samples was beyond 0.025 mg/l. There were 3 villages with arsenic level in drinking water beyond Chinese National Permissible Limits (0.050 mg/l), and the prevalence rate of arsenism reached 37.0% in these three villages, 3.7%, 22.2%, and 11.1% of subjects suffering from mild, moderate, and severe arsenism, respectively. Conclusively, the wide distribution of high-fluoride drinking waters contributes to the prevalence of dental and skeletal fluorosis in Shaanxi province and the quality of fluoride-reducing projects should be further improved. Ore mining and smelting induces high-arsenic drinking waters, resulting in arsenism prevalence in Shang-luo city. Proper measures should be taken to deal with water pollution in the ore mining and smelting areas in order to solve the high-arsenic water problem in Shaanxi province.     

Assessment of water contribution on total fluoride intake of various age groups of people in fluoride endemic and non-endemic areas of Dindigul District, Tamil Nadu, South India

The prevalence of fluorosis is mainly due to the intake of large quantities of fluoride through water. It is necessary to determine the contribution of water used for drinking and food processing and other diet sources on daily fluoride intake for finding the ways to reduce the excess fluoride intake than the minimum safe level intake of 0.05 mg/kg/day. The main objectives of this study are to determine the quantitative impact of water through drinking and cooking of food and beverages on total fluoride intake as well as to estimate the contribution of commonly consumed diet sources on total fluoride intake. Contribution of water on daily fluoride intake and estimation of total fluoride intake through the diet sources were accomplished through analysis of fluoride in drinking water, solid and liquid food items, Infant formulae, tea and coffee infusions using fluoride ion selective electrode. Determination of incidence of fluorosis in different fluoride endemic areas in Dindigul District of Tamil Nadu, South India is achieved through clinical survey. The percentage of daily fluoride intake through water is significantly higher for infants than children, adults and old age groups of people. The percentile scores of fluoride intake through water from drinking and cooking increases with increase of water fluoride level. The rate of prevalence of fluorosis is higher in adolescent girls and females than adolescent boys and males residing in high fluoride endemic areas. More than 60% of the total fluoride intake per day derived from water used for drinking and food processing. Hence the people residing in the fluoride endemic areas in Dindigul District of Tamil Nadu, South India are advised to take serious concern about the fluoride level of water used for drinking and cooking to avoid further fluorosis risks.     

Fluoridated ground water and its toxic effects on domesticated animals residing in rural tribal areas of Rajasthan,India

Ground water sources (wells and handpumps) for drinking water in 12 villages of tribal areas of Rajasthan (India) were analysed for evidence of fluoride (F) content. These sources revealed mean F concentration in the range of 1.0 to 5.2 ppm. The toxic effects of fluoride (fluoride toxicity) in the form of osteo‐dental fluorosis were observed in the domesticated immature and mature animals, viz., cattle, buffaloes, goats and sheep. The prevalence of dental fluorosis in calves (< 1 year age) was found to be relatively higher than for adult cattle and buffaloes. Cent percent calves (7/7) were revealed with enamel mottling with varying grades at 3.0 ppm F concentration in ground water, whereas cattle (40/40) and buffaloes (14/14) were at 3.2 ppm. The older buffaloes showed brownish black teeth, not creamy yellow as found in calves and cattle. Out of 516 goats and 468 sheep and their 236 lambs, none showed evidence of osteo‐dental fluorosis. The overall prevalence of skeletal fluorosis was 36.2%, with the highest prevalence of 56.0% in cattle and 59.6% in buffaloes at a mean F concentration of 5.2 ppm. At or more 4.0 ppm F concentration only 28 (7.16%) buffalo calves were found to be affected with skeletal fluorosis. Intermittent lameness occurred in most of the higher age group of animals (>7 years age) at 1.8 ppm F or more in the water. None of the fluorotic animals was found to be affected with hypothyroidism. The prevalence and severity of osteo‐dental fluorosis in these animals was progressive with age. Different effects of fluoride toxicity in cattle and buffaloes are also discussed.     

The impact of the hyperacid Ijen Crater Lake: risks of excess fluoride to human health

The Asembagus irrigation area (East Java, Indonesia) receives a high input of fluoride (F) via surface water that partially originates from the hyperacid crater lake of the Ijen volcano. Endemic dental fluorosis among local residents has been ascribed to F in water wells. In this study, the total F intake by children and adults was estimated, based on concentrations in well waters and foods throughout the area. These values were compared with the Lowest Observed Adverse Effect Level (LOAEL) for dental fluorosis among children and skeletal fluorosis among adults. Fluorosis hazard maps were prepared, identifying the most hazardous locations in the area. It was concluded that there is not only a high risk of dental fluorosis, but also of skeletal fluorosis. Based on the total daily intake, the lowest F concentration in drinking water that poses a risk of developing fluorosis is approximately 0.5 mg/l for dental fluorosis and 1.1 mg/l for skeletal fluorosis. This is below 1.5 mg/l, which is both the guideline value for drinking water from the World Health Organization (WHO) and the Indonesian drinking water standard. This is the first documented case of human health problems that may be directly associated with natural pollutants originating from a volcano-hosted crater lake.     

Monitoring regional fluoride pollution in the Saxonian Ore mountains (Germany) using the biomarker dental fluorosis in roe deer (Capreolus capreolus L.).

The spatial variation of fluoride contamination in the Saxonion part of the Ore mountains (Federal state of Saxony, Germany) was assessed by analysing the prevalence and severity of dental fluorosis in wild male roe deer aged 2 years or more (n = 794) from this region. The study area is exposed to increased atmospheric deposition of fluorides, originating from emission sources in the North-Bohemian brown coal belt. The severity of dental fluorosis in the permanent premolars and molars of one hemimandible per animal was assessed based on a scoring system and a dental lesion index of fluorosis (DLI) assigned to each specimen. On the basis of the mean DLI calculated for the roe deer originating from a certain municipal district, the respective deer sample was assigned to one of seven fluorosis categories, and a map showing the distribution of these categories was produced. Highest fluorosis categories were recorded for roe deer samples from the central and eastern parts of the study area that directly bordered on, or were located near to, the Czech-German border. A close spatial relationship between the main fluoride emission sources in North-Bohemia and the regions with the highest prevalence and severity of dental fluorosis in roe deer was discernible. The observed regional variation of fluoride pollution is in accordance with the results of other studies directly measuring fluoride deposition into the study area or fluoride levels in vegetation. A main advantage of the method used in this study over other ways of recording fluoride contamination of wildlife habitats is that it uses an established and continuously operated system of specimen collection, thereby enabling efficient monitoring with high spatial and temporal resolution at very low cost. Moreover, a clearly recognisable and relevant biological effect is measured which occurs in a dose-dependent manner over a range of environmentally relevant concentrations.     

The effects of fluoride on animals and plants in the South Safi zone

Fluride pollution caused by the factories processing natural phosphates 10 km south of Safi affects animals and plants. Fluoride concentrations are 4–10 times higher in contaminated plants than in plants from the non-polluted areas. Fluoride levels of 700 ppm, 280 ppm, 75 ppm, 25 ppm, and 1.6 ppm were found in grass, forage, straw, barley caryopses and drinking water, respectively. The ingestion of polluted plants and the inhalation of fluoride (as gases and dusts) induce a high daily intake in animals which show important signs and lesions of dental fluorosis. Serious toxicity signs were also observed in plants.     

Fluoride in drinking water and dental fluorosis

In this study we determined the fluoride content in drinking water and hair of 12-year-old schoolchildren from different Serbian municipalities, i.e. Valjevo, Veliko Gradiste, Kacarevo and Vranjska Banja. The analyses were performed using composite fluoride ion-selective electrode. Average fluoride levels were 0.10, 0.15, 0.79 and 11 ppm in well water, 0.07, 0.10, 0.17 and 0.15 ppm in tap water, 19.3, 21.5, 25.4, and 32.5 ppm in hair samples, in Valjevo, Veliko Gradiste, Kacarevo and Vranjska Banja, respectively. Correlation analysis indicated statistically significant positive relationship between fluoride in wells water and fluoride in hair, for all municipalities: correlation coefficients were 0.54 (p < 0.05), 0.89, 0.97 and 0.99 (p < 0.001), in Vranjska Banja, Valjevo, Veliko Gradiste, and Kacarevo, respectively. Positive correlation was obtained also between fluoride in tap water and hair samples in all regions under the study, with statistical significance only in Valjevo municipality, p < 0.05. Dental examination of schoolchildren confirmed dental fluorosis only in the region of Vranjska Banja. Moreover, in endemic fluorotic region of Vranjska Banja, positive and statistically significant correlations were confirmed between fluoride in well water and dental fluorosis level (r = 0.61; p < 0.01) and additionally between fluoride in hair and dental fluorosis level (0.62; p < 0.01). The primary findings from this study have shown that fluoride content in hair is highly correlated with fluoride content in drinking water and dental fluorosis level, indicating that hair may be regarded as biomaterial of high informative potential in evaluating prolonged exposure to fluorides and to individuate children at risk of fluorosis regardless of the phase of teeth eruption.     

Geochemical provinces and the incidence of dental diseases in Sri Lanka.

A survey carried out on the incidence of dental diseases and the distribution of fluoride in drinking water wells in Sri Lanka shows that 3 areas in particular had abundant fluoride (greater than 2ppm). Dental fluorosis was common in areas with high fluoride content while those areas with very little or no fluoride, such as the central region of Sri Lanka, had a high incidence of dental caries. The intensity of rain fall played a major role in the leaching of fluoride ions from soils and it is perhaps this factor which is responsible for the occurrence of a low fluoride zone in the central part of Sri Lanka. The presence of areas containing high fluoride and hence dental fluorosis coincided with geochemical provinces. In these areas, mineral deposits such as apatite and serpentine and also hot spring regions with exhalations of fluorine are found.     

Effect of fluoride on tissue manganese levels in the mouse

Manganese levels were determined in liver, kidney and bone (femur) of mice subjected for 16 weeks to 0 ppm (control), 10 ppm, 25 ppm, 50 ppm, 100 ppm and 200 ppm of fluoride in drinking water. Following fluoride ingestion, manganese levels were significantly reduced in liver (in 50, 100 and 200 ppm groups) and kidney (in 100 and 200 ppm groups). On the other hand, bone manganese levels were significantly elevated following ingestion of 25 ppm or more fluoride. The results suggest that excessive fluoride ingestion disturbs manganese metabolism.     

Health effects of fluoride pollution caused by coal burning

Recently a huge amount of fluoride in coal has been released into indoor environments by the combustion of coal and fluoride pollution seems to be increasing in some rural areas in China. Combustion of coal and coal bricks is the primary source of gaseous and aerosol fluoride and these forms of fluoride can easily enter exposed food products and the human respiratory tract. Major human fluoride exposure was caused by consumption of fluoride contaminated food, such as corn, chilies and potatoes. For each diagnostic syndrome of dental fluorosis, a log-normal distribution was observed on the logarithm of urinary fluoride concentration in students in China. Urinary fluoride content was found to be a primary health indicator of the prevalence of dental fluorosis in the community. In the fluorosis areas, osteosclerosis in skeletal fluorosis patients was observed with a high prevalence. A biochemical marker of bone resorption, urinary deoxypyridinoline content was much higher in residents in China than in residents in Japan. It was suggested that bone resorption was stimulated to a greater extent in residents in China and fluoride may stimulate both bone resorption and bone formation. Renal function especially glomerular filtration rate was very sensitive to fluoride exposure. Inorganic phosphate concentrations in urine were significantly lower in the residents in fluorosis areas in China than in non-fluorosis area in China and Japan. Since airborne fluoride from the combustion of coal pollutes extensively both the living environment and food, it is necessary to reduce fluoride pollution caused by coal burning.     

Water-Availability Assessment and Corresponding Public-Health Implications for a Rural Area in Nigeria

This paper presents a case study which describes water-availability problems and corresponding public-health implications for a rural area in Nigeria. A water-availability assessment was carried out in eight villages which are controlled by the Jalingo Local Government of Taraba State. Questionnaires were used to obtain data from sixty households (approximately 650 participants) concerning issues of water-supply sources, water quantity, water quality and community participation in water-resources projects. It was found that (i) community well water is the major source of water, (ii) 35% of the inhabitants depend on well water during the wet season, and (iii) 69% depend on it during the dry season. About 80% of the households have access to less than 30 litres of water per person per day and, because of low water availability, there is a prevalence of water-related diseases.     

Industrial fluorosis in cattle and buffalo around Udaipur, India

Signs of dental discolouration, difficulty in mastication, bony lesions, lameness, debility and mortality in domesticated animals, reared around superphosphate fertiliser plants located approximately 15 km north of Udaipur, Rajasthan prompted us to investigate for the occurrence of fluorosis. Out of 166 animals clinically examined, the prevalence rate was 17.4% (4/23) in calves below 1 year of age, 37.2% (16/43) in cattle between 1 and 3 years, 61.3% (46/75) in cattle above 3 years and 72% (18/25) in buffalo above 1 year. Dental fluorosis was common in buffalo compared to cattle of all the age groups. Fluoride levels in fodder and water, consumed by the animals were much higher than the recommended permissible limit. Mean fluoride concentrations in serum and urine were 1.53 +/- 1.27 and 26.4 +/- 6.17 mg l(-1) in calves below 1 year of age, 0.56 +/- 0.17 and 26.2 +/- 3.86 mg l(-1) in cattle of 1-3 years, 0.49 +/- 1.13 and 27.5 +/- 4.63 mg l(-1) in cattle above 3 years and 0.60 +/- 0.07 and 28.6 +/- 4.73 mg l(-1) in buffalo over 1 year, respectively. The values were significantly (P < 0.01) higher than those of control animals kept over a 15-km distance from the factories. Fluoride concentrations in the environmental sample collected from the affected locality were 534.4 +/- 74.9 mg kg(-1) in fodder, 1.19 +/- 0.29 mg l(-1) in pond water and 0.479 +/- 0.351 mg l(-1) in tube well water. It was concluded that the consumption of fodder and water contaminated by the fumes and dusts emitting from superphosphate fertiliser plants resulted in the development of chronic fluorotic lesions in cattle and buffalo.     

Potential effect of food processing on the fluoride content of infant foods

Although many authorities accept fluoridation of water as a safe and effective means of preventing caries, there is no consensus in the scientific literature as to the maximum safe daily intake of fluoride from all sources. Further, only a small amount of up-to-date information exists for the fluoride content of foods and beverages other than water. This paper is concerned with infant nutritional regimens and shows that fluoride added during processing may contribute toward substantial unexpected ingestion of fluoride. For some typical regimens fluoride ingestion from only one or two items in the diet may be larger than the maximum safe daily intake recommended by some authorities.     

Arsenic-contaminated cold-spring water in mountainous areas of Hui County, Northwest China: a new source of arsenic exposure

Although pump-well is the primary drinking water source in rural areas of China, there are still 8.4% of villages reliant on cold-spring. In this study, a survey of arsenic concentration in cold-springs and pump-wells was carried out in Hui County, Northwest China. A total of 352 drinking water samples, including 177 cold-springs and 175 pump-wells, were collected. The maximum arsenic concentrations in cold-springs and pump-wells were 0.482 mg/L and 0.067 mg/L, respectively. We found that 15.8% (28) of total cold-springs and 1.1% (2) of total pump-wells had arsenic concentrations exceeding the maximum allowable concentration of arsenic in drinking water of rural China (0.05 mg/L). Our findings show that 5 cold spring-contaminated villages are located in the mountainous areas of Hui County and 2224 inhabitants may be at risk of high arsenic exposure. This paper indicates that arsenic contamination of cold-springs may be more serious than expected in mountainous areas of Northwest China and extensive surveys and epidemiological studies should be carried out to investigate the potential contaminated areas and affected population.     

Drinking water quality in the Ethiopian section of the East African Rift Valley I--data and health aspects

Drinking water samples were collected throughout the Ethiopian part of the Rift Valley, separated into water drawn from deep wells (deeper than 60 m), shallow wells (<60 m deep), hot springs (T>36 degrees C), springs (T<32 degrees C) and rivers. A total of 138 samples were analysed for 70 parameters (Ag, Al, As, B, Ba, Be, Bi, Br, Ca, Cd, Ce, Cl, Co, Cr, Cs, Cu, Dy, Er, Eu, F, Fe, Ga, Gd, Ge, Hf, Hg, Ho, I, In, K, La, Li, Lu, Mg, Mn, Mo, Na, Nb, Nd, Ni, NO(2), NO(3), Pb, Pr, Rb, Sb, Se, Si, Sm, Sn, SO(4), Sr, Ta, Tb, Te, Th, Ti, Tl, Tm, U, V, W, Y, Yb, Zn, Zr, temperature, pH, conductivity and alkalinity) with ion chromatography (anions), spectrometry (ICP-OES and ICP-MS, cations) and parameter-specific (e.g. titration) techniques. In terms of European water directives and WHO guidelines, 86% of all wells yield water that fails to pass the quality standards set for drinking water. The most problematic element is fluoride (F), for which 33% of all samples returned values above 1.5 mg/l and up to 11.6 mg/l. The incidence of dental and skeletal fluorosis is well documented in the Rift Valley. Another problematic element may be uranium (U)-47% of all wells yield water with concentrations above the newly suggested WHO maximum acceptable concentration (MAC) of 2 microg/l. Fortunately, only 7% of the collected samples are above the 10 microg/l EU-MAC for As in drinking water.     

锌铝电极电絮凝法处理高氟饮用水的研究

在双铝极板电絮凝法的基础上引入锌电极,考察锌铝电极电絮凝法对高氟饮用水的除氟效果.静态试验结果表明,采用锌铝电极可以有效降低水中的氟离子浓度,对CODMn和浊度的去除效果优于双铝电极;当原水的氟离子浓度为6 mg/L时,最佳处理条件:锌、铝极板比为1:3、电解电压为18 V、反应pH值为6、反应时间为25～30 min.动态试验结果表明,当进水流量和氟离子浓度分别高达42 mL/min、8 ms/L时,调节进水pH值为6可使其出水中的氟离子浓度达标.     

Fluorine geochemistry in bedrock groundwater of South Korea

High fluoride concentrations (median=4.4 mg/L) in deep bedrock groundwater of South Korea prevent the usage of it as a drinking water source. The hydrogeochemistry of deep thermal groundwaters (N=377) in diverse bedrocks has been studied in order to evaluate the geologic and geochemical controls on fluoride concentrations in groundwater. The groundwater samples were clustered geologically, and the average and median concentrations of fluoride were compared by the Mann-Whitney U test. The order of median fluoride concentration with respect to geology is as follows: metamorphic rocks> or =granitoids > or =complex rock>volcanic rocks> or =sedimentary rocks. This result indicates that the geological source of fluoride in groundwater is related to the mineral composition of metamorphic rocks and granitoids. With respect to groundwater chemistry, the fluoride concentration was highest in Na-HCO3 type groundwater and lowest in Ca-HCO3 type groundwater. Ionic relationships also imply that the geochemical behavior of fluoride in groundwater is related to the geochemical process releasing Na and removing Ca ions. The thermodynamic relationship between the activities of Ca and F indicates that fluoride concentration is controlled by the equilibrium of fluorite (CaF2). In other words, the upper limits of fluoride concentration are determined by the Ca ion; i.e., Ca concentrations play a crucial role in fluoride behavior in deep thermal groundwater. The result of this study suggests that the high fluoride in groundwater originates from geological sources and fluoride can be removed by fluorite precipitation when high Ca concentration is maintained. This provides a basis for a proper management plan to develop the deep thermal groundwater and for treatment of high fluoride groundwater frequently found in South Korea.     

Osteosclerosis due to endemic fluorosis

Endemic water borne fluorosis is a public health problem in Isparta, a city located in southern Turkey. In order to investigate the association between osteosclerosis and fluorosis, we retrospectively screened the results of lumbar spine and femur neck bone mineral density (BMD) of 1500 patients who were examined before, for any reason in between 2001-2003. Sixty nine patients (67 females and 2 males, mean age 52.6+/-10.2) with vertebra T-scores>or=+2 were found only except a patient with osteoid osteoma in the femur neck (femur T-score+6.64). Thirty-four of the patients could be reexamined with lateral vertebra BMD and investigated for fluorosis and the other etiologic causes of osteosclerosis. Of 34 patients, 14 had either mottled tooth enamel or urine fluoride level greater than 1.5 mg/l. Other etiologic causes were hypothyroidism (2), hypoparathyroidism (1), history of lumbar fracture (1), use of retinoids (1), vitamin D (7), oral calcium preparations (9), and bisphosphanates (3). Lateral lumbar vertebral T-score was greater than+2 in 12 patients (35.3%). Femur T-score was greater than+2 in 7 patients (20.6%). Fourteen patients (41.2%) had lateral vertebral or femur T-score>or=+2. Five (35.7%) of these patients had signs of fluorosis, as discussed before. Mean body mass index of individuals with fluorosis was 36.4+/-7.9 and this result was significantly higher than other osteosclerotic subjects (31.6+/-4.4). In conclusion we believe that approximately one third of the osteosclerosis in our region was due to endemic skeletal fluorosis and obesity may enhance this osteosclerotic type bone changes in endemic fluorosis.