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Primary Hypophosphatemic Rickets in an Elderly Woman

Primary Hypophosphatemic Rickets in an Elderly Woman Abstract The appearance of nonfamilial rickets in adults is most frequently due to generalized gastrointestinal malabsorption. Recent studies suggest that rickets secondary to a specific gastrointestinal malabsorption of vitamin D and of calcium is now more common in adults and especially in elderly individuals, possibly because of concomitant dietary deficiencies, inadequate exposure to sunlight, and previous gastric surgery.1 Other conditions which commonly cause rickets are chronic renal glomerular insufficiency and renal tubular disorders such as renal tubular acidosis and the Fanconi syndrome.2 On rare occasions, rickets may complicate hypoparathyroidism, hyperthyroidism, ureterosigmoidostomy, the prolonged ingestion of magnesiumaluminum gel antacids, and hypophosphatasia.2,3 Primary hypophosphatemic rickets (phosphate diabetes) unrelated to the conditions enumerated above may be either familial or sporadic.2 The familial variety is transmitted by sex-linked or autosomal inheritance and usually begins in infancy or childhood, whereas the sporadic variety may occur at any age. The biochemical characteristics of References 1. Chalmers J, Conacher WDH, Gardner DL, et al: Osteomalacia—a common disease in elderly women. J Bone Joint Surg 49B:403-423, 1967. 2. Arnstein AR, Frame B, Frost HM: Recent progress in osteomalacia and rickets. Ann Intern Med 67:1296-1330, 1967.Crossref 3. Lotz M, Ney R, Bartter FC: Osteomalacia and debility resulting from phosphorus depletion. Trans Assoc Amer Physicians 77:281-295, 1964. 4. Wilson DR, York SE, Jaworski ZF, et al: Studies in hypophosphatemic vitamin D-refractory osteomalacia in adults. Medicine 44:99-134, 1965.Crossref 5. Avioli LV, Williams TF, Lund J, et al: Metabolism of vitamin D3-3H in vitamin D-resistant rickets and familial hypophosphatemia. J Clin Invest 46:1907-1915, 1967.Crossref 6. Nagant de Deuxchaisnes C, Krane SM: The treatment of adult phosphate diabetes and Fanconi syndrome with neutral sodium phosphate. Amer J Med 43:508-543, 1967.Crossref 7. Riggs BL, Sprague RG, Jowsey J, et al: Adult-onset vitamin D-resistant hypophosphatemic osteomalacia: Effect of total parathyroidectomy. New Eng J Med 281:762-766, 1969.Crossref 8. Salassa RM, Jowsey J, Arnaud CD: Hypophosphatemic osteomalacia associated with "nonendocrine" tumors. New Eng J Med 283:65-70, 1970.Crossref 9. Heaney RP, Bauer GCH, Bronner F, et al: A normal reference standard for radiocalcium turnover and excretion in humans. J Lab Clin Med 64:21-28, 1964. 10. Aubert JP, Bronner F, Richelle LJ: Quantitation of calcium metabolism: Theory. J Clin Invest 42:885-897, 1963.Crossref 11. Schwartz E, Panariello VA, Saeli J: Radioactive calcium kinetics during high calcium intake in osteoporosis. J Clin Invest 44:1547-1560, 1965.Crossref 12. Neer R, Berman M, Fisher L, et al: Multicompartmental analysis of calcium kinetics in normal adult males. J Clin Invest 46:1364-1379, 1967.Crossref 13. Kendall MJ: The influence of age on the xylose absorption test. Gut 11:498-501, 1970.Crossref 14. Moss AJ, Waterhouse C, Terry R: Gluten-sensitive enteropathy with osteomalacia but without steatorrhea. New Eng J Med 272:825-830, 1965.Crossref 15. Hunter J, Maxwell JD, Stewart DA, et al: Altered calcium metabolism in epileptic children on anticonvulsants. Brit Med J 4:202-204, 1971.Crossref 16. Dent CE: Rickets (and osteomalacia), nutritional and metabolic (1919-69). Proc Roy Soc Med 63:401-408, 1970. 17. Chalmers J: Osteomalacia: A review of 93 cases. J Roy Coll Surg Edinb 13:255-275, 1968. 18. Anderson I, Campbell AER, Dunn A, et al: Osteomalacia in elderly women. Scot Med J 11:429-435, 1966. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Primary Hypophosphatemic Rickets in an Elderly Woman

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Publisher
American Medical Association
Copyright
Copyright © 1973 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1973.00320100109015
Publisher site
See Article on Publisher Site

Abstract

Abstract The appearance of nonfamilial rickets in adults is most frequently due to generalized gastrointestinal malabsorption. Recent studies suggest that rickets secondary to a specific gastrointestinal malabsorption of vitamin D and of calcium is now more common in adults and especially in elderly individuals, possibly because of concomitant dietary deficiencies, inadequate exposure to sunlight, and previous gastric surgery.1 Other conditions which commonly cause rickets are chronic renal glomerular insufficiency and renal tubular disorders such as renal tubular acidosis and the Fanconi syndrome.2 On rare occasions, rickets may complicate hypoparathyroidism, hyperthyroidism, ureterosigmoidostomy, the prolonged ingestion of magnesiumaluminum gel antacids, and hypophosphatasia.2,3 Primary hypophosphatemic rickets (phosphate diabetes) unrelated to the conditions enumerated above may be either familial or sporadic.2 The familial variety is transmitted by sex-linked or autosomal inheritance and usually begins in infancy or childhood, whereas the sporadic variety may occur at any age. The biochemical characteristics of References 1. Chalmers J, Conacher WDH, Gardner DL, et al: Osteomalacia—a common disease in elderly women. J Bone Joint Surg 49B:403-423, 1967. 2. Arnstein AR, Frame B, Frost HM: Recent progress in osteomalacia and rickets. Ann Intern Med 67:1296-1330, 1967.Crossref 3. Lotz M, Ney R, Bartter FC: Osteomalacia and debility resulting from phosphorus depletion. Trans Assoc Amer Physicians 77:281-295, 1964. 4. Wilson DR, York SE, Jaworski ZF, et al: Studies in hypophosphatemic vitamin D-refractory osteomalacia in adults. Medicine 44:99-134, 1965.Crossref 5. Avioli LV, Williams TF, Lund J, et al: Metabolism of vitamin D3-3H in vitamin D-resistant rickets and familial hypophosphatemia. J Clin Invest 46:1907-1915, 1967.Crossref 6. Nagant de Deuxchaisnes C, Krane SM: The treatment of adult phosphate diabetes and Fanconi syndrome with neutral sodium phosphate. Amer J Med 43:508-543, 1967.Crossref 7. Riggs BL, Sprague RG, Jowsey J, et al: Adult-onset vitamin D-resistant hypophosphatemic osteomalacia: Effect of total parathyroidectomy. New Eng J Med 281:762-766, 1969.Crossref 8. Salassa RM, Jowsey J, Arnaud CD: Hypophosphatemic osteomalacia associated with "nonendocrine" tumors. New Eng J Med 283:65-70, 1970.Crossref 9. Heaney RP, Bauer GCH, Bronner F, et al: A normal reference standard for radiocalcium turnover and excretion in humans. J Lab Clin Med 64:21-28, 1964. 10. Aubert JP, Bronner F, Richelle LJ: Quantitation of calcium metabolism: Theory. J Clin Invest 42:885-897, 1963.Crossref 11. Schwartz E, Panariello VA, Saeli J: Radioactive calcium kinetics during high calcium intake in osteoporosis. J Clin Invest 44:1547-1560, 1965.Crossref 12. Neer R, Berman M, Fisher L, et al: Multicompartmental analysis of calcium kinetics in normal adult males. J Clin Invest 46:1364-1379, 1967.Crossref 13. Kendall MJ: The influence of age on the xylose absorption test. Gut 11:498-501, 1970.Crossref 14. Moss AJ, Waterhouse C, Terry R: Gluten-sensitive enteropathy with osteomalacia but without steatorrhea. New Eng J Med 272:825-830, 1965.Crossref 15. Hunter J, Maxwell JD, Stewart DA, et al: Altered calcium metabolism in epileptic children on anticonvulsants. Brit Med J 4:202-204, 1971.Crossref 16. Dent CE: Rickets (and osteomalacia), nutritional and metabolic (1919-69). Proc Roy Soc Med 63:401-408, 1970. 17. Chalmers J: Osteomalacia: A review of 93 cases. J Roy Coll Surg Edinb 13:255-275, 1968. 18. Anderson I, Campbell AER, Dunn A, et al: Osteomalacia in elderly women. Scot Med J 11:429-435, 1966.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1973

References