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Normophosphatemic Vitamin D-Resistant Osteomalacia in a Patient with Normal Calcium and Fat Absorption

MORDECHAI WARON, M.D.; MARTHA STAUFFER, M.D.; DAVID BAYLINK, M.D.; and CLAYTON RICH, M.D., F.A.C.P.
[+] Article and Author Information

▸Requests for reprints should be addressed to Martha E. Stauffer, M.D., Veterans Administration Hospital, 4435 Beacon Ave. South, Seattle, Wash. 98108


Seattle, Washington


Ann Intern Med. 1971;75(3):415-419. doi:10.7326/0003-4819-75-3-415
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The clinical data, calcium metabolic studies, and histological examination of bone in a patient with severe progressive bone demineralization are discussed with respect to the etiology of the bone disease. Several features are consistent with osteomalacia: multiple pseudofractures, subperiosteal resorption, hypocalcemia, increased calcium retention after an intravenous infusion of calcium, decreased bone apposition, and increased amount of bone surface lined by osteoid. Osteoid seam width was not increased, however, and fat and calcium absorption and response to an NH4Cl load all were normal. Because vitamin D antirachitic activity was present in serum, and treatment with vitamin D and sodium fluoride did not lead to clinical improvement, this patient may have an acquired abnormality of bone cells associated with progressive skeletal demineralization and plastic deformities.

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