180 



D. B. Morgan, C. R. Paterson, C. G. Woods, C. N. Pulvertaft, P. Fourman 



-i; 50 



of 1,000 units. Three patients also had calcium 2 g daily. The bone pains disappeared 

 within 3 to 12 weeks. Some Looser's nodes healed. Fig. 1 shows that the alkaline 

 phosphatase in the serum, remarkably constant before treatment, nearly always 

 changed greatly and significantly after treatment but the direction of the change 



varied. In 3 patients it fell to 

 near normal after 3, 31/2 and 

 5 months. In 3 patients it rose, 

 from 30 to 40, from 32 to 45 

 and from 42 to 90 K.A. units 

 per 100 ml. In one patient it did 

 not change at all. Changes in 

 the serum calcium and phospho- 

 rus were small and inconsistent. 

 Two patients had a second bi- 

 opsy after 4 and 5 months of 

 treatment. In one who had had 

 calcium the broad osteoid seams 

 had disappeared; in the other, 

 who had not had calcium, they 

 were beginning to calcify. It is 

 clear that these patients had 

 responded to 1,000 units weekly 

 of vitamin D 2. 



We have studied in more 

 detail the immediate response 

 to vitamin D. 



Dr. Ph. Bordier had sug- 

 gested to us that a fall in 

 the phosphate clearance is the 

 most sensitive sign of response to vitamin D in patients with osteomalacia. Because it 

 is difficult to measure the rate of urine excretion accurately, it is difficult to measure 

 clearances accurately and we have therefore resorted to the use of the ratio phosphate 

 Cp 



c,.,. 



c,, 

 c 



20 



2 1 1 2 J V S 6 7 8 

 Months or treatment 



Fig. 1. Changes in serum alkaline phosphatase of 6 pari 

 osteomalacia treated with weekly injections of 1000 units vitamin 

 D 2. In one patient the serum alkaline phosphatase did not change 

 and these data have been omitted from the figure 



ith 



clearance/creatinine clearance 

 It may be recalled that the 



which is independent of the urine volume. 



is related to the tubular reabsorption of phospho- 



C, 



rus according to the formula TRP == 1 — '' where TRP is the net proportion of 

 phosphorus reabsorbed from the glomerular filtrate by the renal tubule. '' is said 



to be high in osteomalacia (Nordin and Fraser, 1956), supposedly as a result of 

 parathyroid compensation. 



The J' was measured in 3 of the patients with osteomalacia and in two patients 



without osteomalacia (Fig. 2). In two of the patients with osteomalacia it was more 

 than 0.2 and it fell during the four days' treatment with vitamin D. In the third 

 patient with osteomalacia and in the two without it was less than 0.2 and it did not 

 fall. One of the patients who responded to 100 units of vitamin D daily had not 



