When Rao tried to perform the biopsy, the woman's bone was so hard he said his instrument could not penetrate the bone. "It was like steel," he said. "Her bone density was very high, seven times denser than normal."
The outlook for the patient is positive, however. Rao said he knows from his experience in India that if a person moves from an area with high fluoride concentration in the water to an area with low fluoride concentration, their bones can get healthier. But it's hard to know how long it will take for the body to rid itself of the excess fluoride accumulation, he noted.
The fluoride would naturally be removed from the bone by "bone remodeling," a process that occurs throughout life to replace mature bone tissue with new bone. But in adults, the pace of that process is unpredictable and typically rather slow, Rao explained.
The patient stopped drinking tea and her pain has diminished, said Rao. Now he is considering a variety of approaches to try to speed up the process of ridding her body of the excess fluoride.
Giving her parathyroid hormone may help speed up the removal of fluoride from the bone, but it could also increase bone density more than would be advisable, and the right dose is tough to pin down, he noted. The hormone controls calcium, phosphorus and vitamin D levels in the blood and bone. Another option would be to put her on a low calcium, low vitamin D diet, he said.
Dr. Joseph Lane, chief of the metabolic bone disease service at Weill Cornell Medical College, in New York City, said this case study shows the risk of adopting an unusual diet. "I had a patient who started taking a lot of fish oil, and then she had a minor injury and bled a lot, almost like hemophilia [a disease in which it is hard for blood to clot]. It turns out the patient had too much vitamin E in the blood," Lane explained.
Lane suggests that people talk with their physician about any change in their diet they are considering, especially if it is somewhat unusual. As for off-the-shelf food and beverage items, he suggests taking a close look at the ingredients.