Tea Drinker’s Fluorosis

Presentation Number: SUN 321
Date of Presentation: April 2nd, 2017

Rim Hasan*1, Muhammad Talha2 and Robert S Weinstein2
1Central Arkansas Veterans Health Care System/University of Arkansas for Medical sciences, Little Rock, AR, Little Rock, AR, 2Central Arkansas Veterans Healthcare System/University of Arkansas for Medical Sciences, Little Rock, AR

Abstract

Background: Chronic ingestion of high amounts of fluoride may lead to sclerotic skeleton that is prone to fractures. Tea is rich in fluoride, especially the inexpensive “brick” tea. Consumption of a gallon or more of this tea daily can lead to skeletal fluorosis (1). Here, we describe such a patient.

Clinical case: A 56 year old Caucasian lady from Arkansas was found to have sclerotic bone on an abdominal CT scan done for workup for abdominal pain of unknown etiology. She had no skeletal complaints, bone pain, or history of fractures. Her past medical history was significant for chronic kidney disease attributed to chronic NSAID use. Her creatinine was 1.3-1.4 mg/dL (n=0.4-1.0 mg/dL). Bone mineral density by DEXA revealed a Z score of +5.9 at the lumbar spine and +2.7 at the femoral neck. Further work-up revealed elevated iPTH (191 pg/mL n=12.0-88.0 pg/mL), elevated ionized calcium (1.35mmol/L n=1.15-1.33 mmol/L), elevated alkaline phosphatase (305 IU/L n= 32-91 IU/L) and normal 25-hydroxyvitamin D (44 ng/mL n= 30.0-100.0 ng/mL) and normal phosphorous (4.3mg/dL n=2.5-4.5 mg/dL). Serum fluoride level was 210 mcg/L (n=15–50 mcg/liter) (2). Dietary history revealed that she consumed 1-2 gallons of Luzianne tea per day for the past 15 years. She used 4-5 tea bags per U.S. gallon of tap water boiled in a Teflon-coated pot and steeped for 30 min to an hour. She denied taking any other fluoride supplementation, and did not brush her teeth more than twice per day, had no exposure to glues or cements, and had no known liver disease. Her elevated fluoride levels supported the diagnosis of skeletal fluorosis. We advised the patient to decrease her tea consumption.

 Conclusion: Tea drinking is popular in the United States.  Physicians should be aware that skeletal fluorosis can result from consumption of excessive amount of tea.

 

Nothing to Disclose: RH, MT, RSW