Vitamin D and Liver Disease

To the Editor: In their review of vitamin D metabolism, Haussler and McCain state that osteomalacia is not normally associated with liver disease and infer that vitamin D metabolism may be unimportant in this situation.¹ Bone thinning in liver disease has been recognized for many years,² and histologic evidence of osteomalacia has been reported in numerous series.^{3 4 5 6} The observed low serum 25-hydroxyvitamin D (25-OHD) concentrations in patients with chronic liver disease appear to be related more to lack of vitamin D substrate than to a failure of 25-hydroxylation, for serum 25-OHD values usually become normal with vitamin D treatment.⁷⁸ Reed. No extract is available for articles shorter than 400 words.