A young girl had tibial osteotomies at age 14 for genu valgum and then had recurrent tibia) cysts over a number of years. Hypocalcemia and hyperphosphatemia were first noted at age 21. The diagnosis of pseudohypoparathyroidism was made at age 28, when elevated plasma PTH was detected. Clinical and biochemical features, including a PTH response test and assay of RBC G_s, established the diagnosis of pseudohypoparathyroidism type lb. Failure to suppress plasma PTH with vitamin D therapy led to an exacerbation of her cystic bone disease; there were widespread lytic lesions radiologically, most of which took up [^99mTc]diphosphonate on bone scan. Microradioscopy revealed evidence of resorption of phalangeal tufts. Bone biopsy showed osteitis fibrosa cystica. During an orthopedic procedure, trabecular bone fragments were taken from her right humerus, and bone‐derived cells cultured using an explant technique. The cultured cells were osteoblast‐like in morphology, fully responsive to PTH, cholera toxin, forskolin, and PGE₁ in vitro, and had an alkaline phosphatase and osteocalcin response to 1,25‐dihydroxyvitamin D₃ [1,25‐(OH)₂D₃]. Following this examination of skeletal responsiveness, attempts were made to suppress the elevated plasma PTH levels and symptomatic bone disease by optimizing therapy with oral 1,25‐(OH)₂D₃. When bone pain associated with the cystic bone disease failed to resolve, the patient underwent total parathyroidectomy, following which the bone pain gradually resolved. This is the first direct demonstration of PTH responsiveness in cultured bone cells in the syndrome of pseudohypoparathyroidism with osteitis fibrosa cystica.