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ABSTRACT. A 44-yr-old woman with a 16-yr history of heavy antacid ingestion was evaluated for severe weight loss, weak-ness, bone pain, and multiple fractures. Laboratory investiga-tion revealed severe hypophosphatemia with undetectable phosphate in the urine. Serum parathyroid hormone (PTH), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels were normal. Transiliac bone biopsy revealed evidence of mineral-ization defect compatible with hypophosphatemic osteomala-The clinical and pathological features of the phosphate depletion syndrome (PDS) have been increasingly rec-ognized in recent years.’-3 PDS has been associated with common disorders such as alcoholism, anorexia, inflam-matory bowel disease with chronic diarrhea, and faddist or generally poor diets low in phosphate-rich foods such as milk and milk products, meat, fish, and eggs. Hypo