{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T03:33:13Z","timestamp":1773804793128,"version":"3.50.1"},"reference-count":39,"publisher":"The Endocrine Society","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background:<\/jats:title>\n                  <jats:p>High fluoride ion (F\u2212) levels are found in many surface and well waters. Drinking F\u2212-contaminated water typically explains endemic skeletal fluorosis (SF). In some regions of Asia, however, poor quality \u201cbrick tea\u201d also causes this disorder. The plant source of brick, black, green, orange pekoe, and oolong tea, Camellia sinensis, can contain substantial amounts of F\u2212. Exposure to 20 mg F\u2212 per day for 20 yr of adult life is expected to cause symptomatic SF. High F\u2212 levels stimulate osteoblasts and enhance bone apposition but substitute for OH\u2212 groups in hydroxyapatite crystals and thereby result in skeletal fragility and perhaps lead to secondary hyperparathyroidism. Beginning in 2005, we showed that daily consumption of 1\u20132 gallons of instant tea made from this plant can lead to SF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim:<\/jats:title>\n                  <jats:p>We describe a 48-yr-old American woman who developed SF from brewed tea.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patient and Methods:<\/jats:title>\n                  <jats:p>Our patient had elevated bone mineral density revealed by dual-energy x-ray absorptiometry (spine Z-score, +9.9), severe chronic bone and joint pain, and kyphosis after consuming 1\u20132 gallons of brewed orange pekoe tea daily for more than three decades. F\u2212 levels were high in her serum, urine, and clippings of fingernails and toenails, as well as in our reproduction of her beverage. Renal function was normal. She had vitamin D deficiency. Elevated serum PTH levels were unresponsive to adequate vitamin D supplementation. Pain resolved over several months when she stopped drinking tea and continued ergocalciferol.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion:<\/jats:title>\n                  <jats:p>Our patient shows that SF can result from chronic consumption of large volumes of brewed tea.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jc.2010-2891","type":"journal-article","created":{"date-parts":[[2011,5,19]],"date-time":"2011-05-19T02:52:41Z","timestamp":1305773561000},"page":"2318-2324","source":"Crossref","is-referenced-by-count":48,"title":["Skeletal Fluorosis from Brewed Tea"],"prefix":"10.1210","volume":"96","author":[{"given":"Kenneth","family":"Izuora","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids (K.I., J.G.T., R.P.), Department of Medicine, Emory University, School of Medicine, Atlanta, Georgia 30322; Department of Oral Biology (G.M.W.), Medical College of Georgia, Augusta, Georgia 30912; Musculoskeletal Disease Section (J.D.), Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, Washington University School of Medicine, St. Lou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer G.","family":"Twombly","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids (K.I., J.G.T., R.P.), Department of Medicine, Emory University, School of Medicine, Atlanta, Georgia 30322; Department of Oral Biology (G.M.W.), Medical College of Georgia, Augusta, Georgia 30912; Musculoskeletal Disease Section (J.D.), Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, Washington University School of Medicine, St. Lou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary M.","family":"Whitford","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids (K.I., J.G.T., R.P.), Department of Medicine, Emory University, School of Medicine, Atlanta, Georgia 30322; Department of Oral Biology (G.M.W.), Medical College of Georgia, Augusta, Georgia 30912; Musculoskeletal Disease Section (J.D.), Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, Washington University School of Medicine, St. Lou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Demertzis","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids (K.I., J.G.T., R.P.), Department of Medicine, Emory University, School of Medicine, Atlanta, Georgia 30322; Department of Oral Biology (G.M.W.), Medical College of Georgia, Augusta, Georgia 30912; Musculoskeletal Disease Section (J.D.), Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, Washington University School of Medicine, St. Lou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Pacifici","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids (K.I., J.G.T., R.P.), Department of Medicine, Emory University, School of Medicine, Atlanta, Georgia 30322; Department of Oral Biology (G.M.W.), Medical College of Georgia, Augusta, Georgia 30912; Musculoskeletal Disease Section (J.D.), Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, Washington University School of Medicine, St. Lou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Whyte","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids (K.I., J.G.T., R.P.), Department of Medicine, Emory University, School of Medicine, Atlanta, Georgia 30322; Department of Oral Biology (G.M.W.), Medical College of Georgia, Augusta, Georgia 30912; Musculoskeletal Disease Section (J.D.), Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, Washington University School of Medicine, St. Lou"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","reference":[{"key":"2020071617560360300_B1","first-page":"279","article-title":"Skeletal fluorosis in humans: a review of recent progress in the understanding of the disease.","volume":"10","author":"Krishnamachari","year":"1986","journal-title":"Prog Food Nutr Sci"},{"key":"2020071617560360300_B2","volume-title":"Health effects of ingested fluoride","author":"Subcommittee on Health Effects of Ingested Fluoride, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council","year":"1993"},{"key":"2020071617560360300_B3","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S0278-6915(02)00285-5","article-title":"Brick tea fluoride as a main source of adult fluorosis.","volume":"41","author":"Cao","year":"2003","journal-title":"Food Chem Toxicol"},{"key":"2020071617560360300_B4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1038\/sj.jea.7500259","article-title":"Fluoride concentrations in three types of commercially packed tea drinks in Taiwan.","volume":"13","author":"Lung","year":"2003","journal-title":"J Expo Anal Environ Epidemiol"},{"key":"2020071617560360300_B5","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1159\/000262142","article-title":"Fluoride content in caffeinated, decaffeinated and herbal teas.","volume":"30","author":"Chan","year":"1996","journal-title":"Caries Res"},{"key":"2020071617560360300_B6","unstructured":"Economic Research Service, U.S. Department of Agriculture\n          Food availability (per capita) data system. Available at: http:\/\/www.ers.usda.gov\/data\/foodconsumption\/spreadsheets\/beverage.xls.Accessed: May 5, 2011"},{"key":"2020071617560360300_B7","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.amjmed.2004.07.046","article-title":"Skeletal fluorosis and instant tea.","volume":"118","author":"Whyte","year":"2005","journal-title":"Am J Med"},{"key":"2020071617560360300_B8","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1359\/jbmr.080101","article-title":"Skeletal fluorosis from instant tea.","volume":"23","author":"Whyte","year":"2008","journal-title":"J Bone Miner Res"},{"key":"2020071617560360300_B9","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1093\/jn\/135.9.2247","article-title":"Elevated serum fluoride concentrations in women are not related to fractures and bone mineral density.","volume":"135","author":"Sowers","year":"2005","journal-title":"J Nutr"},{"key":"2020071617560360300_B10","first-page":"46","article-title":"Renal handling of fluoride","volume-title":"The metabolism and toxicity of fluoride","author":"Whitford","year":"1996"},{"key":"2020071617560360300_B11","first-page":"685","article-title":"Monitoring fluoride exposure with fingernail clippings.","volume":"115","author":"Whitford","year":"2005","journal-title":"Schweiz Monatsschr Zahnmed"},{"key":"2020071617560360300_B12","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/0039-9140(68)80109-2","article-title":"Determination of submicromolar concentrations of fluoride in biological samples.","volume":"15","author":"Taves","year":"1968","journal-title":"Talanta"},{"key":"2020071617560360300_B13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1023\/A:1011082608631","article-title":"Accumulation of fluoride and aluminum related to different varieties of tea plant.","volume":"23","author":"Ruan","year":"2001","journal-title":"Environ Geochem Health"},{"key":"2020071617560360300_B14","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1265\/jjh.48.864","article-title":"Contents of aluminum and manganese in tea leaves and tea infusions.","volume":"48","author":"Matsushima","year":"1993","journal-title":"Nippon Eiseigaku Zasshi"},{"key":"2020071617560360300_B15","first-page":"1410","volume-title":"Goldfrank's toxicologic emergencies","author":"Goldfrank","year":"1998","edition":"6th ed"},{"key":"2020071617560360300_B16","first-page":"1647","article-title":"Agents affecting mineral ion homeostasis and bone turnover","volume-title":"Goodman and Gilman's the pharmacological basis of therapeutics","author":"Friedman","year":"2005","edition":"11th ed"},{"key":"2020071617560360300_B17","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1056\/NEJM199003223221203","article-title":"Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis.","volume":"322","author":"Riggs","year":"1990","journal-title":"N Engl J Med"},{"key":"2020071617560360300_B18","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1136\/bmj.1.5854.637","article-title":"Secondary hyperparathyroidism in patients with endemic skeletal fluorosis.","volume":"1","author":"Teotia","year":"1973","journal-title":"Br Med J"},{"key":"2020071617560360300_B19","article-title":"Serum parathyroid hormone levels in chronic endemic fluorosis","author":"Koroglu","year":"2010","journal-title":"Biol Trace Elem Res"},{"key":"2020071617560360300_B20","article-title":"Review of fluoride: benefits and risks. Report of the ad hoc subcommittee on fluoride of the committee to coordinate environmental health and related programs","author":"Public Health Service, Department of Health and Human Services","year":"1991"},{"key":"2020071617560360300_B21","unstructured":"U.S. Environmental Protection Agency\n          2006\n          Drinking water contaminants. Available at: http:\/\/water.epa.gov\/drink\/contaminants\/index.cfm#List. Accessed November 7, 2010"},{"key":"2020071617560360300_B22","volume-title":"Health effects of ingested fluoride","author":"National Research Council Subcommittee on Health Effects of Ingested Fluoride","year":"1993"},{"key":"2020071617560360300_B23","article-title":"Bottled water (codified at 21CFR\u00a7165.110)","year":"2003"},{"key":"2020071617560360300_B24","volume-title":"UNICEF handbook on water quality","author":"United Nations Children's Fund","year":"2008"},{"key":"2020071617560360300_B25","volume-title":"Fluoride in drinking-water","author":"Fawell","year":"2006"},{"key":"2020071617560360300_B26","article-title":"Fluoride in drinking-water: background document for development of WHO guidelines for drinking-water quality","author":"World Health Organization","year":"2004"},{"key":"2020071617560360300_B27","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.fct.2007.10.039","article-title":"Assessment of fluoride concentration and daily intake by human from tea and herbal infusions.","volume":"46","author":"Malinowska","year":"2008","journal-title":"Food Chem Toxicol"},{"key":"2020071617560360300_B28","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1834-7819.1985.tb05829.x","article-title":"The fluoride content of some teas available in Australia.","volume":"30","author":"Smid","year":"1985","journal-title":"Aust Dent J"},{"key":"2020071617560360300_B29","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/00220345750540012501","article-title":"Effect of cooking vessel composition on fluoride.","volume":"54","author":"Full","year":"1975","journal-title":"J Dent Res"},{"key":"2020071617560360300_B30","first-page":"26","article-title":"Effect of aluminum and Teflon cooking vessels on fluoride content of boiling water.","volume":"57","author":"Shannon","year":"1977","journal-title":"J Mo Dent Assoc"},{"key":"2020071617560360300_B31","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.amjmed.2005.05.028","article-title":"Fluoride levels in bottled teas.","volume":"119","author":"Whyte","year":"2006","journal-title":"Am J Med"},{"key":"2020071617560360300_B32","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0025-6196(11)61192-0","article-title":"Fluoride-related bone disease associated with habitual tea consumption.","volume":"82","author":"Hallanger Johnson","year":"2007","journal-title":"Mayo Clin Proc"},{"key":"2020071617560360300_B33","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jbspin.2007.04.016","article-title":"Spinal cord compression revealing fluorosis.","volume":"75","author":"Hafsa","year":"2008","journal-title":"Joint Bone Spine"},{"key":"2020071617560360300_B34","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1359\/jbmr.060912","article-title":"Recovery from skeletal fluorosis (an enigmatic, American case).","volume":"22","author":"Kurland","year":"2007","journal-title":"J Bone Miner Res"},{"key":"2020071617560360300_B35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1385\/JCD:8:1:001","article-title":"Misinterpretation of osteodensitometry with high bone density (BMD \u2265 + 2.5 is not \u201cnormal\u201d).","volume":"8","author":"Whyte","year":"2005","journal-title":"J Clin Densitom"},{"key":"2020071617560360300_B36","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1097\/00001648-199807000-00011","article-title":"Use of toe-nail fluoride levels as an indicator for the risk of hip and fore-arm fractures in women.","volume":"9","author":"Feskanich","year":"1998","journal-title":"Epidemiology"},{"key":"2020071617560360300_B37","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1159\/000075934","article-title":"Fingernails and toenails as biomarkers of sub-chronic exposure to fluoride from dentifrice in 2-to-3-year-old children.","volume":"38","author":"Corr\u00eaa Rodrigues","year":"2004","journal-title":"Caries Res"},{"key":"2020071617560360300_B38","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/carcin\/bgm233","article-title":"Molecular mechanism of black tea polyphenols induced apoptosis in human skin cancer cells: involvement of Bax translocation and mitochondria mediated death cascade.","volume":"29","author":"Halder","year":"2008","journal-title":"Carcinogenesis"},{"key":"2020071617560360300_B39","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1002\/jemt.20721","article-title":"Effect of black tea on histological and immunohistochemical changes in pancreatic tissues of normal and streptozotocin-induced diabetic mice (Mus musculus).","volume":"72","author":"Manikandan","year":"2009","journal-title":"Microsc Res Tech"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/96\/8\/2318\/9085981\/jcem2318.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/96\/8\/2318\/9085981\/jcem2318.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T03:40:30Z","timestamp":1594957230000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/96\/8\/2318\/2834028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,8,1]]},"references-count":39,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2011,8,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jc.2010-2891","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,8,1]]}}}