{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T11:41:36Z","timestamp":1760010096779,"version":"build-2065373602"},"reference-count":34,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,18]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>A woman in her late 50s with a history of multiple prior orthopaedic surgeries presented with severe left hip pain. Initial pelvic radiographs showed diffuse sclerosis, cortical thickening and coarse trabeculae, suggesting polyostotic Paget\u2019s disease or another metabolic disorder. However, further imaging revealed widespread skeletal sclerosis and cortical thickening throughout the axial skeleton. In addition, a history of chronic inhalant abuse was reported in the medical record. In conjunction with the patient\u2019s history of computer duster abuse and potential difluoroethane exposure, a subsequent diagnosis of diffuse skeletal fluorosis was made. Subsequently, the patient underwent a left total hip arthroplasty, and pathological examination of the resected femoral head revealed enlarged, irregular trabeculae and high osteoclastic activity, compatible with osteosclerotic bone disease. This case highlights the diagnostic challenges of complex medical histories, particularly when patients may not be forthcoming about inhalant abuse and underscores the importance of comprehensive evaluation and long-term monitoring.<\/jats:p>","DOI":"10.1136\/bcr-2025-266543","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T11:10:14Z","timestamp":1760008214000},"page":"e266543","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Total hip arthroplasty for diffuse skeletal fluorosis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4227-6163","authenticated-orcid":false,"given":"Tony","family":"Chang","sequence":"first","affiliation":[{"name":"School of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"},{"name":"Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn J","family":"Steven","sequence":"additional","affiliation":[{"name":"Department of Radiology-Musculoskeletal Imaging, Stanford Medicine, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Charville","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford Medicine, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek F.","family":"Amanatullah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"2025100904100487000_18.10.e266543.1","article-title":"Skeletal Fluorosis: An Unusual Manifestation of Computer Cleaner Inhalant Abuse","volume":"12","author":"Liane","year":"2020","journal-title":"Cureus"},{"key":"2025100904100487000_18.10.e266543.2","article-title":"Skeletal Fluorosis in a Patient With Computer Cleaner Inhalant Abuse","volume":"15","author":"Chen","year":"2023","journal-title":"Cureus"},{"key":"2025100904100487000_18.10.e266543.3","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1752-7325.1995.tb02331.x","article-title":"Fluoride and bone health","volume":"55","author":"Phipps","year":"1995","journal-title":"J Public Health Dent"},{"key":"2025100904100487000_18.10.e266543.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-007-0437-6"},{"key":"2025100904100487000_18.10.e266543.5","article-title":"Fluoride for treating postmenopausal osteoporosis","volume":"2000","author":"Haguenauer","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"2025100904100487000_18.10.e266543.6","doi-asserted-by":"publisher","DOI":"10.1177\/0022034510384626"},{"key":"2025100904100487000_18.10.e266543.7","doi-asserted-by":"publisher","DOI":"10.1177\/0022034514520708"},{"key":"2025100904100487000_18.10.e266543.8","first-page":"279","article-title":"Skeletal fluorosis in humans: a review of recent progress in the understanding of the disease","volume":"10","author":"Ka","year":"1986","journal-title":"Prog Food Nutr Sci"},{"key":"2025100904100487000_18.10.e266543.9","doi-asserted-by":"crossref","first-page":"00144","DOI":"10.5435\/JAAOSGlobal-D-21-00077","article-title":"Rare Case of Diffuse Skeletal Fluorosis Due to Inhalant Abuse of Difluoroethane","volume":"5","author":"Suwak","year":"2021","journal-title":"JAAOS Glob Res Rev"},{"key":"2025100904100487000_18.10.e266543.10","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1007\/s00198-024-07137-x","article-title":"Skeletal fluorosis: an uncommon cause, yet a rescue treatment?","volume":"35","author":"Shariff","year":"2024","journal-title":"Osteoporos Int"},{"key":"2025100904100487000_18.10.e266543.11","article-title":"Troponemia Secondary to Air Duster Inhalant Abuse","volume":"9","author":"Romero","year":"2022","journal-title":"Eur J Case Rep Intern Med"},{"key":"2025100904100487000_18.10.e266543.12","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1056\/NEJMicm2103503","article-title":"Skeletal Fluorosis","volume":"385","author":"Meena","year":"2021","journal-title":"N Engl J Med"},{"key":"2025100904100487000_18.10.e266543.13","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/jbmr.2923","article-title":"Skeletal Fluorosis Due To Inhalation Abuse of a Difluoroethane-Containing Computer Cleaner","volume":"32","author":"Tucci","year":"2017","journal-title":"J Bone Miner Res"},{"key":"2025100904100487000_18.10.e266543.14","unstructured":"ARUP Laboratories . 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