Skeletal Fluorosis Due To Inhalation Abuse of a Difluoroethane-Containing Computer Cleaner

Authors

  • Joseph R Tucci,

    Corresponding author
    1. Department of Medicine, Roger Williams Medical Center, Providence, RI, USA
    2. Boston University School of Medicine, Boston, MA, USA
    • Address correspondence to: Joseph R Tucci, MD, Division of Endocrinology, Roger Williams Medical Center, Boston University School of Medicine, Boston, MA, USA. E-mail: jrtuccimd@yahoo.com

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  • Gary M Whitford,

    1. Department of Oral Biology, School of Dental Medicine, George Regents University, Augusta, GA, USA
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  • William H McAlister,

    1. Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
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  • Deborah V Novack,

    1. Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
    2. Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
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  • Steven Mumm,

    1. Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
    2. Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
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  • Tony M Keaveny,

    1. Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA
    2. Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA
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  • Michael P Whyte

    1. Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
    2. Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
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  • Presented at: Lawrence Raisz Memorial New England Bone Club Meeting, March 22, 2013, Portsmouth, NH, USA.

ABSTRACT

Skeletal fluorosis (SF) is endemic in many countries and millions of people are affected worldwide, whereas in the United States SF is rare with occasional descriptions of unique cases. We report a 28-year-old American man who was healthy until 2 years earlier when he gradually experienced difficulty walking and an abnormal gait, left hip pain, loss of mobility in his right wrist and forearm, and progressive deformities including enlargement of the digits of both hands. Dual-energy X-ray absorptiometry (DXA) of his lumbar spine, femoral neck, total hip, and the one-third forearm revealed bone mineral density (BMD) Z-scores of +6.2, +4.8, +3.0, and –0.2, respectively. Serum, urine, and bone fluoride levels were all elevated and ultimately explained by chronic sniffing abuse of a computer cleaner containing 1,1-difluoroethane. Our findings reflect SF due to the unusual cause of inhalation abuse of difluoroethane. Because this practice seems widespread, particularly in the young, there may be many more such cases. © 2016 American Society for Bone and Mineral Research.

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