Sir.—We have read the article by Dwyer et al (Journal 133:134-140, 1979) and have recently observed an adult case of nutritional osteomalacia similar to those presented.
Report of a Case.—A 25-year-old woman came to this hospital with a chief complaint of increasing bone pain in the lower back and hips, which caused difficulty in walking for one year. For the past eight years, she had been on a strictly vegan diet that also excluded fish. Soy products were her only dietary supplement. Her four children (from 11 months to 7 years of age) are also on the same diet. Since the birth of her last child, the patient has continued to lactate and admitted to a 7-kg weight loss in the Past year. The patient was referred to the department of rehabilitation medicine due to severe muscle weakness, wasting, and lethargy. She walked with the aid of a cane.