Skeletal fluorosis is a chronic metabolic bone disease caused by the ingestion of large amounts of fluoride through either water or food in geographic areas where high levels of fluoride occur naturally.

Voriconazole is a trifluorinated azole drug that has been purported to cause a diffuse asymmetric periostitis secondary to elevated fluoride levels. Fluoride forms fluorapatite, which stimulates osteoblastic activity and periostitis 7.

Radiographic features

Plain radiograph/CT

Described features include:

Involvement of the axial skeleton is characteristic, and changes are most marked in the spine, pelvis, and ribs.

In early fluorosis, the first changes are bone deposition and thickening at the junctions of trabeculae. This is seen as a sand-like, granular, or particle-like bone structure on radiographs.

In more advanced fluorosis, the trabeculae are more generally thickened because of new bone formation on the trabecular surface. At this stage, radiographs show thickening and condensation of trabeculae, with coarse reticulum or woven bone striations.

If the trabeculae are fused, focal round densities are seen in the medullary bone.

Osteopenia (less common) also may occur in fluorosis, especially in younger patients at an earlier stage 6.

Calcification of the sacrotuberous ligament is considered a characteristic feature.

Differential diagnosis

For diffuse skeletal sclerosis on imaging, consider:

Article information

rID: 21142
Synonyms or Alternate Spellings:
  • Endemic skeletal fluorosis
  • Skeletal fluorosis

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Cases and figures

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