Cross-sectional study reveals higher serum fluoride correlates with severe knee osteoarthritis in an endemic region, indicating safe water interventions may reduce joint disease burden.
BACKGROUND: Osteoarthritis (OA) is a major cause of disability globally. Recent evidence suggests a potential role of environmental fluoride in musculoskeletal degeneration. OBJECTIVE: To evaluate the association between fluoride levels in serum, urine, and drinking water and the severity of OA in adults from a fluorosis-endemic region. METHODS: In this cross-sectional study, 119 adults with radiologically confirmed knee OA from Yadadri-Bhuvanagiri, Telangana, were evaluated. OA severity was graded using the Kellgren-Lawrence (KL) system. Pain and function were assessed using the visual analog scale (VAS) and the knee injury and osteoarthritis outcome score (KOOS). Fluoride levels in serum, urine, and household drinking water were measured as biomarkers of systemic and environmental fluoride exposure. RESULTS: Moderate-to-severe OA (KL grades 3-4) was found in 60 (50.4%) participants. Significantly higher serum fluoride levels were observed in this group (p=0.007). The use of untreated underground water was associated with advanced OA (OR: 3.6; CI: 1.3-9.8). Water purification using reverse osmosis systems was associated with better VAS (p=0.02) and KOOS scores (p=0.05). CONCLUSION: Higher fluoride biomarker levels, especially in serum, are significantly associated with greater OA severity. Public health strategies focusing on safe water access and routine fluoride surveillance may mitigate OA burden in endemic areas.
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Dhole et al. (2025) studied this question.
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