Abstract
A postmenopausal osteopenic woman presented with recurrent stress fractures of the feet and normal parameters of mineral homeostasis. Despite the absence of biochemical or radiographic evidence, severe osteomalacia was documented by histomorphometric analysis of a tetracycline labeled, non-decalcified bone biopsy. This observation underscores the need for specific bone biopsy confirmation of skeletal disease in patients with fracture-prone osteopenia.