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METABOLIC BONE DISEASE.

Several diffuse bone diseases result from either vitamin D deficiency or inherited disorders of the enzymes concerned with vitamin D metabolism. Osteomalacia, with bone pain, fractures and proximal muscle wasting, frequently results from inadequate exposure to sunlight, the consequence of which is loss of the major source of vitamin D, because of deficient production from 7-dehydrocholesterol. The parent vitamin undergoes a series of hydroxylations resulting in generation of the active form, responsible for the absorption of calcium and phosphate and making it available for normal bone mineralization. Rickets in childhood and osteomalacia in adults result from impaired supply or impaired regulation, and understanding of the regulation of vitamin D metabolism is necessary in approaching diagnosis and therapy