ONTROPICAI~ SPRUE with its associated malabsorption of calcium and vitamin D (not to mention the del!ective absorption o~ [oodstuffs, minerals, vitamins, and water) is one of the known causes of secondary hyperparathyroidism. ~-:~ The following case of sprue is presented because of the extreme degree of the resultant osteitis fibrosa cystica. CASE REPORT Mrs. G. B. (U.M.H. 006454), a M-year-old Caucasian. came to the Arthritis Clinic of The University of Michigan Medical Center in March 1962, with complaints of joint pains, limitation of motion, and generalized weakness of 53 years' duration. She had been told that at age 2 she had "inflammatory rheumatism," and since then she had continued to have nonmigratory arthralgias not suggestive of inflammatory joint discase. She had never sustained fractures. In the past few years she had had continuous pain in her knees, hips, low hack, and left thigh, and had been harely ahle to walk. Since age 19 she had lost 5 in. in height. Concomitant with the chihlhood arthralgias, the diagnosis of "TB of the bowels" had been made on the basis of intractahle diarrhea. The patient's physical devdopment was retarded: she weighed only 18 lb. at age 3 and did not walk until age 5, at which time movement was awkward and accompanied by frequent leg pains and falling. From infancy to age 5 she had had almost continual "drawing-up" of her extremities, with the wrists, elbows, and knees held in llexion position. Mena~che was at age t9, with menopause at age 41. On admiKsion the patient weighed 104 lb. She had lost 30 lb. in the past 25 yr. and had increasing difficulty in satisfying her hunger. She had persistently noted bulky, frothy, malodorous, floating, tan stools which adhered to the sides of the howl, occurring 6-8 times a day, mostly nocturnally. Anemia of 30 years' duration had been symptomatically treated with liver injections,
