Radiological aspects of a new type of bone fluorosis, periostitis deformans.

Abstract

In 1952 one of the authors described a new bone disease, which was called periostitis deformans (1, 2), and in 1964 he identified it as a new type of bone fluorosis due to habitual drinking of wine containing fluorine—wine fluorosis (3). Although this disease is rare, 28 cases have been observed in Spain since the time of its original description. Many others have undoubtedly passed unnoticed, since a high proportion of them have been erroneously diagnosed as benign and malignant bone tumors, chronic osteomyelitis, chronic polyarthritis, rheumatoid disease, and tabetic arthropathy or Paget's osteitis deformans. The x-ray examination of bones is sufficient to establish the diagnosis, some special features having a pathognomonic value. The condition is of considerable interest, as in several countries fluorine is customarily added in excessive quantities to wine as a preservative (4, 5). The subsequent intoxication remains unsuspected by both patient and attending physician in the majority of cases, so that frequently the disease is discovered initially by the radiologist. Periostitis Deformans and Fluorosis Changes Our cases of periostitis deformans were carefully studied from clinical, radiological, and pathological points of view, and the findings were compared with those in classical bone fluorosis of drinking water or professional origin and with those in experimental fluorosis. Common Changes in Fluorosis The typical pathological features seen in roentgenograms of all patients with chronic fluorosis may be classified in four wide groups of lesions, as follows: 1. Endosteal changes or fluoric osteitis: (a) condensing osteitis, visualized as sclerotic or osteopetrosis-like bone changes; (b) rarefying osteitis, characterized by porotic and malacic bone aspects; (c) sclero-atrophic osteitis, a mixed form. 2. Periosteal changes due to fluoric periostitis, which appear as osteogenic periosteal proliferations. 3. Pathological changes in tendinous and muscular structures around the bones, which may be considered as osteophytosis invading the soft tissues (invading osteophytosis). 4. Joint changes or fluoric arthrosis. Typical Changes in Periostitis Deformans The following are typical features of periostitis deformans: 1. Endosteal changes due to sclero-atrophic osteitis: A slow initial osteosclerosis appears, which gradually resolves into osteoporosis and bone atrophy. We have termed this process “sclero-atrophic osteitis” (Figs. 1 and 4). 2. Periosteal changes developed through outbreaks of periostitis deformans: Periodically subacute outbreaks are observed of hyperostotic periostitis.