Boulétreau PH, Bost M, Fontanges E, Lauverjat M, Gutknecht C,Ecochard R, Delmas PD, Chambrier C - "Fluoride exposure and bone status in patients with chronic intestinal failure who are receiving home parenteral nutrition" American Journal of Clinical Nutrition, 83(6): 1429-1437 (2006)
Background and Objective: Metabolic bone disease is frequent in
chronic intestinal failure. Because fluoride has a major effect on
bones, the status of both fluoride and bone was studied in long-term
home parenteral nutrition (HPN) patients.
Design: We studied 31 adults aged ( ± SD) 56.3 ± 15.1 y, mainly
patients with short-bowel syndrome, who had been receiving HPN for
>1 y. Bone mineral density (BMD) was measured by absorptiometry, and
serum fluoride was measured by using a fluoride-sensitive electrode.
All patients ate and drank ad libitum. HPN (3.4 ± 1.2 times/wk)
complemented oral nutrition. Potential explicative factors were
estimated by using a linear regression model (mixed-effects model).
Results: Of 120 fluoride dosages (2–6/patient), 102 were above the
upper normal limit (1.58 µmol/L) at the laboratory. Mean (± SD)
daily fluoride supply was 8.03 ± 7.71 mg (US adequate intake: 3.1
mg/d for women and 3.8 for men; tolerable upper normal limit: 10
mg/d); intravenous fluoride varied from 0.06 to 1.45 mg, and oral
fluoride varied from 0.09 to 27.8 mg. Serum fluoride concentrations
were correlated with creatinine clearance and fluoride supply. BMD
was significantly lower in the femoral neck than in the spinal area.
After adjustment for sex and the duration of HPN, only the effect of
serum fluoride on spinal BMD was significant. Two patients had
symptoms of fluorosis, eg, calcaneum fissures, interosseous
calcifications, or femoral neck osteoporosis.
Conclusions: In chronic intestinal failure, high intakes of fluoride
are frequent because of the beverages ingested to compensate for
stool losses. Hyperfluoremia has an effect on bone metabolism and
may increase skeletal fragility. The consumption of fluoride-rich
beverages for extended periods is therefore not advisable.