title: Skeletal Fluorosis Due To Inhalation Abuse of a Difluoroethane-Containing Computer Cleaner.
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.
authors.affiliation: Department of Medicine, Roger Williams Medical Center, Providence, RI, USA.|Boston University School of Medicine, Boston, MA, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Tucci
authors.affiliation: Department of Oral Biology, School of Dental Medicine, George Regents University, Augusta, GA, USA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Whitford
authors.affiliation: Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: McAlister
authors.affiliation: Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.|Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.
authors.forename: Deborah V
authors.initials: DV
authors.lastname: Novack
authors.affiliation: Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.|Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Mumm
authors.affiliation: Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA.|Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA.
authors.forename: Tony M
authors.initials: TM
authors.lastname: Keaveny
authors.affiliation: Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.|Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Whyte
mesh_terms: D000328:Adult; D001847:Bone Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D003201:Computers; D004550:Elbow / Q000000981:diagnostic imaging; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology; D020342:Finite Element Analysis; D006801:Humans; D006845:Hydrocarbons, Fluorinated; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D006845:Hydrocarbons, Fluorinated; C059268:1,1-difluoroethane
keywords: FLUORIDE; HYPEROSTOSIS; OSTEOSCLEROSIS; PERIOSTITIS