Skeletal Fluorosis Related to Habitual Tea Consumption: Long-Term Follow-Up After Reduction and Discontinuation of Tea

Objective: Systemic fluorosis due to excessive tea consumption is a cause of acquired osteosclerosis. Reversibility of systemic fluorosis and long-term outcome data are essentially limited to a few case reports and has never been reported in the context of fluorosis due to chronic excessive tea intake. Methods: We previously reported on 4 patients with fluoride excess due to habitual tea consumption with a wide disease spectrum, including skeletal fluorosis, gastrointestinal symptoms, lower extremity pain, and renal insufficiency. Herein, we report long-term follow-up on two of those subjects. Results: Reduction and discontinuation of tea intake was associated with rapid improvement of bone pain, renal function, and gastrointestinal symptoms. Reversibility of osteosclerosis and reductions in bone mineral density were also observed over several years after reduction and elimination of the fluoride source. An initial decrease in plasma fluoride levels occurred, followed by a plateau at above-normal levels persisting up to 11.5 years thereafter. Conclusion: Elimination of retained skeletal fluoride from chronic excessive tea ingestion may take longer than previous estimates, although specific patient-related factors including reduced renal function may have also contributed to the continued plasma fluoride elevations.