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Original Contribution
May 11, 1964

Milkman's Syndrome Secondary to Phosphate Diabetes

Author Affiliations

Lebanon, Pa

From the medical and radiology services, Veterans Administration Hospital.

JAMA. 1964;188(6):496-500. doi:10.1001/jama.1964.03060320018004

Milkman, in 1930 reported on his case with symmetrical pseudofractures involving hones otherwise normal radiographically. He claimed that his patient had a new disease or syndrome of undetermined etiology. A case report is presented of a man who in 1945 was found to have symmetrical pseudofractures. Hypophosphatemia, hyperphosphaturia, and elevated serum alkaline phosphatase have been consistent findings. His condition progressively deteriorated until phosphate supplement was added to the conventional therapy when improvement resulted. Review of the literature suggests that Milkman's patient had phosphate diabetes and developed pseudofractures before there was x-ray evidence of generalized osteomalacia. Probably many cases of Milkman's syndrome are due to phosphate diabetes and phosphate supplement may be of benefit in therapy.

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