Step 1: Skeletal fluorosis results from chronic excessive fluoride intake, which stimulates osteoblasts and causes abnormal new bone formation and mineralisation.
Step 2: The increased dense bone is seen radiologically as osteosclerosis, particularly involving the axial skeleton (spine and pelvis).
Step 3: Excess bone also deposits in the cortex, producing cortical thickening that encroaches on the medullary cavity. At tendon and ligament attachments fluoride drives ossification, giving enthesopathy and ligamentous calcification, along with large spinal osteophytes.
Step 4: Because osteosclerosis, cortical thickening, and enthesopathy are all genuine features of fluorosis, the answer is All the above.