Therapeutic Response and Effect on the Kidney of 100 Units Vitamin D 179 



Of the patients surveyed, 6 had classical osteomalacia. The incidence of osteo- 

 malacia among patients with a Polya gastrectomy was 1 per cent for men and 3 per 

 cent for women. There were 2 other patients not drawn from the survey with osteo- 

 malacia after gastrectomy. These 8 patients all had bone pain; 4 had Looser's 

 nodes; all had a raised serum alkaline phosphatase activity; all had extensive osteoid 

 seams in a bone biopsy. 



Table 1 shows the prevalence of a raised alkaline phosphatase and of a low 

 calcium concentration in the serum of 975 of the patients in the survey with the 

 more common operations compared with 185 patients with peptic ulcer who did not 

 have an operation. Many operated patients had a raised alkaline phosphatase but so 

 did many unoperated patients. While this abnormality is more common in the 



Table 1. Prevalence of raised alkaline phosphatase and of low serum calcium concentration 



in the serum of 975 patients after gastric surgery and 185 patients with peptic ulcer who 



had not had an operation 



Serum alkaline 

 phosphatase 



> 12 K. A. units 

 per 100 ml. 



< 9.1 mg 

 per 100 ml 



Men 



VGE = Vagotomy and gastroenterostomy V. Ant'y = Vagotomy and antrectomy 

 Gast'y = Gastrectomy 



operated patients, it is misleading to estimate the prevalence of osteomalacia after 

 gastrectomy from the number of patients with a raised alkaline phosphatase (Jones 

 et al., 1962; Clark et al., 1964). A low serum calcium was more frequent in patients 

 who had had an operation than in those who had not. A low plasma protein concen- 

 tration accounted for about half of the low values for the serum calcium in the 

 operated patients. The meaning of the low serum calcium in the remainder is not yet 

 clear. 



103 operated patients had a bone biopsy. In the patients with a raised alkaline 

 phosphatase or a low serum calcium who did not have bone pain the biopsies were 

 seldom abnormal. There was an excess of osteoid in about one-sixth of these biopsies 

 but the seams were narrow, with no more than three laminae, and they covered less 

 than 30''/o of the trabecular surface. There was little cellular reaction. The biopsies 

 of the patients with osteomalacia selected for this report had broad osteoid seams 

 with 3 — 12 laminae; the seams covered the trabeculae completely. Osteoblasts 

 covered part of the surface but there was remarkably little osteoclastic activity. 



The final confirmation of a diagnosis of osteomalacia depends on the response to 

 treatment with vitamin D. Simple deficiency of vitamin D should respond to small 

 doses. In 7 patients we tried the effect of 130 units daily given as a weekly injection 



