Vitamin-D-Resistant Osteomalacia

Abstract

The place of so-called “vitamin-D-resistant rickets and osteomalacia” is considered, followed by the report of the case of a woman aged 32 with osteomalacia and Milkman’s syndrome. Other causes for osteomalacia were ruled out, and various metabolic investigations were then performed. Balance studies showed a high faecal calcium and phosphorus, phosphorus infusion studies showed a low tubular maximal reabsorption of phosphorus (high phosphate clearance), and calcium infusion studies showed several points of difference from the normal. The bones gave evidence of great avidity for calcium. The response to parathyroid extract was slight, delayed, and affected calcium more than phosphorus metabolism. The effect of calciferol given parenterally in large doses was examined. On 1.2 million units per day the calcium and phosphorus absorption increased, but it was not until a dose of 4.8 million units daily was used that the serum phosphorus showed any rise. No toxic effects were seen on this dose after 14 days. The smaller dose of 1.2 million units had no effect on the tubular reabsorption of phosphate. Finally the mechanism of production of Looser's zones is considered. The relation of some of the zones to arteries was studied by means of contrast medium introduced into the aorta. It is concluded that the zones are not in close connexion with pulsating blood vessels. © 1958, British Medical Journal Publishing Group. All rights reserved.