Skeletal fluorosis from instant tea

Michael P. Whyte, William G. Totty, Vivienne T. Lim, Gary M. Whitford

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Introduction: Skeletal fluorosis (SF) can result from prolonged consumption of well water with >4 ppm fluoride ion (F-; i.e., >4 mg/liter). Black and green teas can contain significant amounts of F -. In 2005, SF caused by drinking 1-2 gallons of double-strength instant tea daily throughout adult life was reported in a 52-yr-old woman. Materials and Methods: A 49-yr-old woman developed widespread musculoskeletal pains, considered fibromyalgia, in her mid-30s. Additionally, she had unexplained, increasing, axial osteosclerosis. She reported drinking 2 gallons of instant tea each day since 12 yr of age. Fluoxetine had been taken intermittently for 5 yr. Ion-selective electrode methodology quantitated F - in her blood, urine, fingernail and toenail clippings, tap water, and beverage. Results: Radiographs showed marked uniform osteosclerosis involving the axial skeleton without calcification of the paraspinal, intraspinal, sacrotuberous, or iliolumbar ligaments. Minimal bone excrescences affected ligamentous attachments in her forearms and tibias. DXA Z-scores were +10.3 in the lumbar spine and +2.8 in the total hip. Her serum F- level was 120 μg/liter (reference range, 20-80 μg/liter), and a 24-h urine collection contained 18 mg F-/g creatinine (reference value, <3). Fingernail and toenail clippings showed 3.50 and 5.58 mg F-/kg (control means, 1.61 and 2.02, respectively; ps < 0.001). The instant tea beverage, prepared as usual extra strength using tap water with ∼1.2 ppm F-, contained 5.8 ppm F-. Therefore, the tea powder contributed ∼35 mg of the 44 mg daily F- exposure from her beverage. Fluoxetine provided at most 3.3 mg of F- daily. Conclusions: SF from habitual consumption of large volumes of extra strength instant tea calls for recognition and better understanding of a skeletal safety limit for this modern preparation of the world's most popular beverage.

Original languageEnglish (US)
Pages (from-to)759-769
Number of pages11
JournalJournal of Bone and Mineral Research
Volume23
Issue number5
DOIs
StatePublished - May 1 2008

Fingerprint

Tea
Beverages
Nails
Drinking
Fluoxetine
Reference Values
Ion-Selective Electrodes
Musculoskeletal Pain
Urine Specimen Collection
Fibromyalgia
Water
Tibia
Fluorides
Ligaments
Forearm
Skeleton
Powders
Hip
Creatinine
Spine

Keywords

  • Antioxidants
  • Aspartame
  • Fibromyalgia
  • Flavonoids
  • Fluoridation
  • Fluoride
  • Fluoxetine
  • Fracture
  • High bone mass
  • Hyperostosis
  • Keratin
  • Osteoarthritis
  • Osteoblast
  • Osteophytosis
  • Osteosclerosis
  • Water filtration

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Skeletal fluorosis from instant tea. / Whyte, Michael P.; Totty, William G.; Lim, Vivienne T.; Whitford, Gary M.

In: Journal of Bone and Mineral Research, Vol. 23, No. 5, 01.05.2008, p. 759-769.

Research output: Contribution to journalArticle

Whyte, Michael P. ; Totty, William G. ; Lim, Vivienne T. ; Whitford, Gary M. / Skeletal fluorosis from instant tea. In: Journal of Bone and Mineral Research. 2008 ; Vol. 23, No. 5. pp. 759-769.
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