{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T23:25:51Z","timestamp":1775690751262,"version":"3.50.1"},"reference-count":75,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2008,5,1]],"date-time":"2008-05-01T00:00:00Z","timestamp":1209600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Introduction: Skeletal fluorosis (SF) can result from prolonged consumption of well water with &amp;gt;4 ppm fluoride ion (F\u2212; i.e., &amp;gt;4 mg\/liter). Black and green teas can contain significant amounts of F\u2212. In 2005, SF caused by drinking 1\u20132 gallons of double-strength instant tea daily throughout adult life was reported in a 52-yr-old woman.<\/jats:p>\n               <jats:p>Materials and Methods: A 49-yr-old woman developed widespread musculoskeletal pains, considered fibromyalgia, in her mid-30s. Additionally, she had unexplained, increasing, axial osteosclerosis. She reported drinking 2 gallons of instant tea each day since 12 yr of age. Fluoxetine had been taken intermittently for 5 yr. Ion-selective electrode methodology quantitated F\u2212 in her blood, urine, fingernail and toenail clippings, tap water, and beverage.<\/jats:p>\n               <jats:p>Results: Radiographs showed marked uniform osteosclerosis involving the axial skeleton without calcification of the paraspinal, intraspinal, sacrotuberous, or iliolumbar ligaments. Minimal bone excrescences affected ligamentous attachments in her forearms and tibias. DXA Z-scores were +10.3 in the lumbar spine and +2.8 in the total hip. Her serum F\u2212 level was 120 \u03bcg\/liter (reference range, 20\u201380 \u03bcg\/liter), and a 24-h urine collection contained 18 mg F\u2212\/g creatinine (reference value, &amp;lt;3). Fingernail and toenail clippings showed 3.50 and 5.58 mg F\u2212\/kg (control means, 1.61 and 2.02, respectively; ps &amp;lt; 0.001). The instant tea beverage, prepared as usual extra strength using tap water with \u223c1.2 ppm F\u2212, contained 5.8 ppm F\u2212. Therefore, the tea powder contributed \u223c35 mg of the 44 mg daily F\u2212 exposure from her beverage. Fluoxetine provided at most 3.3 mg of F\u2212 daily.<\/jats:p>\n               <jats:p>Conclusions: SF from habitual consumption of large volumes of extra strength instant tea calls for recognition and better understanding of a skeletal safety limit for this modern preparation of the world's most popular beverage.<\/jats:p>","DOI":"10.1359\/jbmr.080101","type":"journal-article","created":{"date-parts":[[2008,1,7]],"date-time":"2008-01-07T18:25:06Z","timestamp":1199730306000},"page":"759-769","source":"Crossref","is-referenced-by-count":45,"title":["Skeletal Fluorosis From Instant Tea"],"prefix":"10.1093","volume":"23","author":[{"given":"Michael P","family":"Whyte","sequence":"first","affiliation":[{"name":"Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St Louis, Missouri, USA"},{"name":"Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, Missouri, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William G","family":"Totty","sequence":"additional","affiliation":[{"name":"Musculoskeletal Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivienne T","family":"Lim","sequence":"additional","affiliation":[{"name":"Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St Louis, Missouri, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary M","family":"Whitford","sequence":"additional","affiliation":[{"name":"Department of Oral Biology and Maxillofacial Pathology, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2009,12,4]]},"reference":[{"key":"2024020319541354800_bib1","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":"2024020319541354800_bib2","volume-title":"Review of Fluoride: Benefits and Risks. 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