A quantitative histological examination was made of iliac-crest biopsy specimens obtained from 125 cases of fracture of the proximal femur (102 women and 23 men). 35 women (34%) demonstrated a more severe degree of osteoporosis than would be expected for their age and 35 (including 10 of those with osteoporosis) had some evidence of osteomalacia. There was some evidence of osteomalacia in 11 (47%) men. 5 women and 2 men with osteomalacia had previously undergone partial gastrectomy. It is suggested that osteomalacia in the elderly makes an important contribution to the steep rise in femoral-neck fractures with advancing age in the U.K. and that this is attributable to an absolute or relative deficiency of vitamin D. It is also suggested that at least some of the osteoporotic component may also be attributable to a degree of vitamin-D deficiency sufficient to cause malabsorption of calcium but not sufficient to produce osteomalacia.
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