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May 28, 1982

Long-term Use of Tetracycline

JAMA. 1982;247(20):2780. doi:10.1001/jama.1982.03320450018017

To the Editor.—  We read the article on "The Significance of Yellow Bone: Evidence for Tetracycline in Adult Human Bone" (1981;246:761) by Oklund et al. Based on the demonstration of tetracycline fluorophore in donor bones in three men, who did not have an antecedent history of jaundice or hepatic or metabolic disorders, the authors conclude that long-term use of tetracycline in therapeutic dosages in the human adult has no known deleterious effect and that tetracycline in bone appears safe for the human carrier.We disagree with the conclusions of Oklund et al. We recently saw a 21-year-old woman who died of tetracycline-associated fatty liver at 38 weeks of pregnancy and in whom we demonstrated gross and microscopic fluorescence of tetracycline in bone. Tissue extraction and quantitative chemical analysis showed 60 mg of tetracycline per gram of wet bone tissue.1 Initially, we could elicit no history of tetracycline ingestion from