Multiple symmetrical fractures of bone of unresolved etiology.

The clinical, laboratory, and radiologic picture of a unique patient with symmetrical fractures of the anterior tibial midshafts, dorsal ulnar cortices, and lateral metatarsals is presented. The findings are not compatible with a diagnosis of osteogenesis imperfecta or osteomalacia despite osseous fragility. The elevated serum pyrophosphate and low urine phosphate content suggest that abnormalities in phosphate metabolism may have contributed to the formation of bone which is biochemically and structurally deficient.