How ancient rocks and climate change cause arthritis in Telangana’s women

Hyderabad: The granite bedrock beneath Yadadri-Bhuvanagiri district has been leaching poison into groundwater for millennia. But now, as climate patterns shift and water tables drop, this ancient geological curse has found a new way to torment rural communities—by crippling their joints.

A study from the All India Institute of Medical Sciences (AIIMS), Bibinagar in the state, published in the medical journal Cureus, reveals how environmental factors have transformed Telangana’s fluoride contamination from a dental problem into an arthritis epidemic.

Fluoride levels above WHO safe levels

In villages where underground water sources contain fluoride levels above the World Health Organization’s safe limit of 1.5 mg/L, residents face 3.6 times higher odds of developing severe osteoarthritis.

The research reveals an environmental health crisis decades in the making, where geological formations, climate pressures and human adaptation failures have converged to poison an entire generation’s mobility.

The geological culprit

Telangana’s fluoride problem begins deep underground, where ancient granite and gneissic rock formations have been slowly dissolving for aeons. These rocks, formed billions of years ago when the Earth’s crust first solidified, contain fluoride-bearing minerals that seep into groundwater through natural weathering processes.

“Fluoride, a naturally occurring element found in rocks and groundwater, helps prevent dental caries at optimal concentrations (0.7-1.0 mg/L) as per WHO guidelines,” researchers noted. But Telangana’s geology doesn't follow WHO guidelines. The state’s crystalline rock basement ensures that fluoride concentrations in many areas far exceed safe limits.

Geogenic contamination zone in Yadadri-Bhuvanagiri

The Yadadri-Bhuvanagiri district sits atop some of the most fluoride-rich geology in the region. Here, groundwater has been accumulating fluoride for thousands of years, creating what scientists call a geogenic contamination zone – an area where the earth itself poisons its water supply.

This geological legacy has haunted the region since humans first settled here. The earliest documented fluorosis case emerged in 1945 in Bhatlapally village, Marriguda mandal, Nalgonda district. Since then, over 967 habitations in former Nalgonda alone have reported fluoride-related health issues, with the problem eventually spreading to 28 out of 33 districts across Telangana.

Climate change amplifies the crisis

Environmental pressures have intensified Telangana’s fluoride problem in recent decades.

Erratic rainfall patterns, extended droughts and rising temperatures have forced communities to drill deeper borewells, tapping into older groundwater reserves with higher fluoride concentrations.

A 2024 Government of India survey results paint a stark picture: 14.87 per cent of over 1,150 groundwater samples exceeded the safe fluoride limit. In Yadadri-Bhuvanagiri district specifically, 48.84 per cent of sampled locations showed fluoride levels above permissible limits – making it one of the most contaminated areas in the state.

This isn’t just a numbers game. Each percentage point represents thousands of people whose daily water intake slowly destroys their skeletal system. The AIIMS study tracked this destruction in real time, documenting how environmental fluoride exposure translates into human suffering.

The hidden health impact

The AIIMS research, conducted over 12 months from January to December 2024, followed 119 adults across the Yadadri-Bhuvanagiri district and nearby areas. Most participants were women between 40 and 60 years old – the demographic most vulnerable to fluoride’s joint-destroying effects.

Researchers collected blood, urine and drinking water samples while X-raying participants’ knees to assess arthritis severity using the Kellgren-Lawrence grading system. The results revealed fluoride’s devastating environmental impact on human health.

“The mean serum fluoride level was 0.6±0.3 mg/L, the mean urinary fluoride was 1.0±0.6 mg/L, and the mean fluoride concentration in drinking water was 0.1±0.1 mg/L,” researchers documented. Even water with seemingly low fluoride levels accumulated in participants’ bodies over the years of exposure.

The bioaccumulation pattern mirrors how environmental toxins move through ecosystems. Just as mercury concentrates up the food chain, fluoride builds up in human tissues over decades of consumption. “A total of 97 participants (82.2%) consumed underground water, and only 21 of them (17.9%) reported using RO filtration,” the study found.

Environmental justice and inequality

The fluoride crisis exposes deep environmental inequalities across Telangana.

Wealthy urban areas enjoy treated municipal water supplies, while rural communities remain trapped by their geological circumstances. The AIIMS study reveals how environmental factors determine health outcomes based purely on geography and economic access.

“Radiographic grading using the KL system showed that nine participants (7.6%) had grade 1, 50 (42.0%) had grade 2, 43 (36.1%) had grade 3 and 17 (14.3%) had grade 4 OA,” researchers recorded. Half the participants – 60 people or 50.4% – suffered from moderate-to-severe arthritis directly linked to their environmental exposure.

The gender disparity adds another layer to this environmental injustice. Women comprised 88 per cent of study participants, reflecting social patterns where rural women spend more time at home, consuming local water for cooking and drinking. Their bodies become repositories for decades of environmental contamination.

Age intensified fluoride’s environmental assault. Participants between 51 and 60 faced nearly triple the risk of severe arthritis compared to those in their forties.

“Our findings also underscore the additive effect of age and fluoride exposure. While OA is primarily age-related, chronic fluoride ingestion appears to amplify joint degeneration, suggesting a synergistic mechanism,” researchers observed.

The cellular environmental impact

Fluoride’s environmental damage operates at the cellular level, where it disrupts natural biological processes that have evolved over millions of years.

“Beyond overt skeletal fluorosis, subclinical fluoride toxicity has been implicated in accelerating degenerative joint changes that may mimic or coexist with OA. Fluoride has been shown to disrupt chondrocyte metabolism, promote apoptosis, induce oxidative stress and interfere with extracellular matrix synthesis, mechanisms implicated in OA progression," the study authors explained.

This cellular warfare represents environmental contamination at its most intimate level – where geological toxins interfere with human biology. Fluoride essentially hijacks cellular machinery, turning the body’s own repair mechanisms against itself.

At safe environmental levels (0.7–1.0 mg/L), fluoride strengthens tooth enamel through beneficial chemical reactions. But chronic high exposure triggers environmental toxicity: dental fluorosis yellows and pits teeth, skeletal fluorosis locks joints in painful rigidity, and subclinical damage silently erodes cartilage while ramping up oxidative stress.

Technological solutions and environmental adaptation

The study revealed how technology can disrupt fluoride’s environmental assault.

“Importantly, water purification via RO was significantly associated with lower fluoride levels and improved clinical outcomes. Participants using RO-filtered water reported reduced pain and better functional scores, highlighting the public health value of household-level water treatment in fluoride-endemic areas,” researchers discovered.

Reverse osmosis filtration represents environmental adaptation in action – human technology countering geological contamination. The 21 participants who used RO systems effectively shielded themselves from their toxic environment, their joints ageing naturally instead of under chemical assault.

Inequalities at the core

However, this technological solution exposes deeper environmental inequities. RO systems remain expensive luxuries in affected villages, creating a two-tier system where economic status determines environmental health outcomes.

Telangana’s government claimed complete fluoride mitigation by 2020 following large-scale safe drinking water initiatives. However, the AIIMS study's 2024 findings suggest these environmental interventions may have failed to address the problem's geological roots.

The persistence of fluoride contamination despite government efforts highlights the challenge of managing geogenic pollution. Unlike industrial contamination that can be stopped at its source, geological fluoride contamination requires ongoing environmental management across entire watersheds.

The National Human Rights Commission responded to complaints in 2025, directing action and investigation as contamination continued, causing health risks. Telangana now ranks second in India for high fluoride and nitrate in groundwater – an environmental ranking that translates directly into human suffering.

The diagnostic challenge

The research exposed how environmental contamination complicates medical diagnosis.

“Although skeletal fluorosis is a well-defined clinical condition, its early or subclinical stages may mimic OA or coexist with it, leading to diagnostic uncertainty. Without fluoride biomarker evaluation, many such cases may be misclassified, resulting in inadequate management,” researchers warned.

Environmental health problems often hide behind conventional medical explanations. Doctors treating arthritis in fluoride-endemic areas may miss the environmental component entirely, focusing on age and genetics while ignoring geological toxicity.

“Routine fluoride assessment should be considered in OA workups in endemic regions, particularly when patients present with early-onset or atypical joint degeneration,” researchers recommended. This represents a paradigm shift toward environmental medicine – healthcare that considers geological and climatic factors alongside traditional risk factors.