{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:07:24Z","timestamp":1788934044091,"version":"build-2803163510"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Endemic skeletal fluorosis is a chronic disorder caused by prolonged excessive fluoride intake and is characterized by skeletal hyperostosis, periarticular soft-tissue degeneration, and joint dysfunction. Digital radiography (DR) is the conventional diagnostic modality, but it has limited sensitivity for early soft-tissue changes and provides little dynamic information. Musculoskeletal ultrasound (MSKUS) may address these limitations, yet comparative evidence across major fluorosis subtypes remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To characterize MSKUS findings in endemic skeletal fluorosis and compare the complementary value of MSKUS and DR in water-borne and brick-tea-borne disease cohorts.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective regional comparative study included 246 patients from Jishan County, a predominantly water-borne fluorosis area (\n n<\/jats:italic>\n \u202f=\u202f132), and Ruoergai County, a predominantly brick-tea-borne fluorosis area (\n n<\/jats:italic>\n \u202f=\u202f114). DR was performed at baseline and 3\u202fmonths after fluoride-exposure reduction. MSKUS was performed only at the three-month follow-up and assessed elbow and knee abnormalities and forearm interosseous membrane (IOM) thickness. Because baseline MSKUS was unavailable, ultrasound findings were analyzed cross-sectionally.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients from Jishan County were older (64.73\u202f\u00b1\u202f7.73 vs. 59.35\u202f\u00b1\u202f9.52\u202fyears) and more often female (58.33% vs. 44.83%) than those from Ruoergai County (both\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). Ruoergai patients had higher MSKUS detection rates of humeroulnar joint calcification (78.07% vs. 15.15%), humeroradial joint calcification (48.25% vs. 3.03%), elbow effusion (32.46% vs. 0.76%), and suprapatellar bursa effusion (39.47% vs. 12.12%; all\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). Forearm IOM thickness in pronation was also greater in Ruoergai patients (2.02\u202f\u00b1\u202f0.54 vs. 1.83\u202f\u00b1\u202f0.49\u202fmm;\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). DR showed a higher observed detection rate for radial crest enlargement than MSKUS (94.3% vs. 50.0%), whereas MSKUS showed a higher observed detection rate for radius-ulna IOM calcification (73.6% vs. 15.9%). Fluorosis severity grades differed between baseline and follow-up (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05), but this short interval precludes inference of structural reversal.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n MSKUS and DR provide complementary information in endemic skeletal fluorosis. MSKUS may improve detection of superficial soft-tissue calcification and effusion, whereas DR remains important for osseous abnormalities. Prospective multicenter studies with standardized ultrasound protocols and paired baseline and follow-up MSKUS are warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1877861","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:52:02Z","timestamp":1788933122000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Application of musculoskeletal ultrasound in endemic skeletal fluorosis: a comparative study of water-borne and brick-tea\u2013borne subtypes"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaoli","family":"Hu","sequence":"first","affiliation":[{"name":"Ultrasound Center, Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medical Imaging, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medical Imaging, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangying","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Medical Imaging, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1007\/s40572-020-00270-9","article-title":"Fluoride in drinking water and skeletal fluorosis: a review of the global impact","volume":"7","author":"Srivastava","year":"2020","journal-title":"Curr Environ Health Rep"},{"key":"ref2","volume-title":"Guidelines for Drinking-Water Quality","year":"2017"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1615\/CritRevBiomedEng.v36.i2-3.40","article-title":"Fluoride and mineralized tissues","volume":"36","author":"Chachra","year":"2008","journal-title":"Crit Rev Biomed Eng"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.2214\/ajr.162.1.8273699","article-title":"Endemic fluorosis of the skeleton: radiographic features in 127 patients","volume":"162","author":"Wang","year":"1994","journal-title":"AJR Am J Roentgenol"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-540-28163-4","volume-title":"Ultrasound of the Musculoskeletal System","author":"Bianchi","year":"2007"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1136\/ard.60.7.641","article-title":"Guidelines for musculoskeletal ultrasound in rheumatology","volume":"60","author":"Backhaus","year":"2001","journal-title":"Ann Rheum Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1007\/s00330-011-2356-3","article-title":"Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology","volume":"22","author":"Klauser","year":"2012","journal-title":"Eur Radiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1080\/10643380600678112","article-title":"Fluoride in drinking water: a review on the status and stress effects","volume":"36","author":"Ayoob","year":"2006","journal-title":"Crit Rev Environ Sci Technol"},{"key":"ref9","volume-title":"Fluoride in Drinking-Water","author":"Fawell","year":"2006"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1030344","DOI":"10.3389\/fnut.2022.1030344","article-title":"Brick tea consumption and its relationship with fluorosis in Tibetan areas","volume":"9","author":"Wen","year":"2022","journal-title":"Front Nutr"},{"key":"ref11","doi-asserted-by":"publisher","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":"ref12","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1289\/ehp.961041340","article-title":"The relationship of fluorosis and brick tea drinking in Chinese Tibetans","volume":"104","author":"Cao","year":"1996","journal-title":"Environ Health Perspect"},{"key":"ref13","volume-title":"Diagnostic Standard for endemic Skeletal Fluorosis: WS\/T 192\u20142021","year":"2021"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"17300","DOI":"10.1038\/s41598-017-17328-8","article-title":"Skeletal fluorosis in relation to drinking water in rural areas of West Azerbaijan, Iran","volume":"7","author":"Mohammadi","year":"2017","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"57","DOI":"10.2188\/jea.JE20150037","article-title":"Prevalence of brick tea-type fluorosis in the Tibet autonomous region","volume":"26","author":"Fan","year":"2016","journal-title":"J Epidemiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3967\/bes2017.020","article-title":"Treatment and prevention of skeletal fluorosis","volume":"30","author":"Yang","year":"2017","journal-title":"Biomed Environ Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/S0147-6513(03)00065-4","article-title":"Prevention and control of brick-tea type fluorosis: a 3-year observation in Dangxiong","volume":"56","author":"Cao","year":"2003","journal-title":"Tibet Ecotoxicol Environ Saf"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1877861\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:52:04Z","timestamp":1788933124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1877861\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":17,"alternative-id":["10.3389\/fpubh.2026.1877861"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1877861","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1877861"}}