A far-advanced case of osteomalacia appears to have developed in the absence of marked dietary indiscretions. The milk intake had been ample for at least two years, but no additional vitamin D had been ingested.
The Patient showed a persistent elevation of faecal fat. The history indicated that some degree of steatorrhoea had been present for more than ten years. It seems probable that this mild degree of steatorrhoea over so long a period was a major factor in the development of the osteomalacia. Retention of bone minerals was ample when cod-liver oil, bile-salt, and pancreatin therapies were instituted in conjunction with the ingestion of a diet rich in calcium and phosphorus, and low in fat content.
The authors have encountered one other patient whose spine shows far-advanced osteoporosis and whose stools show elevated faecal fat. It is too early to tell what results dietary and medical management will produce in this case. But it is possible that in a certain number of cases of so-called idiopathic osteoporosis, the primary fault lies in the patient's inability to digest fat.