We have presented the case history of a patient with lifelong, classic nontropical sprue which was previously undiagnosed. She developed secondary hyperparathyroidism with extreme osteitis fibrosa cystica. As do some patients with malabsorption, she presented with musculoskeletal rather than gastrointestinal complaints.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44358/1/10620_2005_Article_BF02235078.pd