THU469 Inhalant Use Resulting In Diffuse Osteosclerosis: Case Report And Review Of The Literature

Disclosure: C. Hung: None. M. Jesse: None. D. Saxon: None. Osteosclerosis of the bone can develop from excessive fluoride intake. Fluoride sources range from oral intake of fluorinated water, ingestion of toothpaste, to fluorocarbon inhalation. Skeletal fluorosis can manifest with bony changes ranging from increased striation/granulation to thickened trabeculae, and ligaments and tendons can ossify (1). In the literature patients have presented after noticing joint enlargement, worsening chronic joint pains, immobility, and stiffness. Workup generally includes radiographs and dual x-ray absorptiometry (DXA) can reveal increased bone density (2). We describe a patient with osteosclerosis and the workup for this condition. We review the existing literature on fluorinated inhalant use as a cause of osteosclerosis. The patient is a 49-year-old man with type 2 diabetes, chronic pain in multiple joints, hypogonadism, and osteomyelitis status post right above knee amputation was referred to Endocrinology after he was found to have sclerotic bone lesions while undergoing workup for poor mobility. X-ray, CT and MRI scans over the past 7 years showed diffuse bone sclerosis in the spine, pelvis, knee, tibia, and foot. Labs demonstrated normal calcium, albumin, and alkaline phosphatase. DXA confirmed elevated T-scores of +6.8 (1.985 g/cm(2)) at left femoral neck, +8.6 (2.097 g/cm(2)) at left proximal femur and +9.8 (2.406 g/cm(2)) at lumbar spine. The patient confirmed “huffing” computer cleaner for 1 year while having severe depression and had stopped inhalant use 7 years prior to presentation. On literature review we identified case reports of bone sclerosis related to inhalant use. Long-term outcomes and optimal management were described only in case reports. Osteosclerosis from fluorosis should be considered in patients with diffusely increased bone density at multiple sites. 1. Wang Y, Yin Y, Gilula LA, Wilson AJ. Endemic fluorosis of the skeleton: radiographic features in 127 patients. AJR Am J Roentgenol. 1994;162(1):93-8. Epub 1994/01/01. doi: 10.2214/ajr.162.1.8273699. PubMed PMID: 8273699.2.Tucci JR, Whitford GM, McAlister WH, Novack DV, Mumm S, Keaveny TM, et al. Skeletal Fluorosis Due To Inhalation Abuse of a Difluoroethane-Containing Computer Cleaner. J Bone Miner Res. 2017;32(1):188-95. Epub 2016/07/28. doi: 10.1002/jbmr.2923. PubMed PMID: 27449958; PubMed Central PMCID: PMCPMC5977397. Presentation: Thursday, June 15, 2023