Rachitic Changes, Demineralization, and Fracture Risk in Healthy Infants and Toddlers with Vitamin D Deficiency

Peréz-Rosselló, Jeannette M.; Feldman, Henry A.; Kleinman, Paul K.; Connolly, Susan A.; Fair, Rick A.; Myers, Regina M.; Gordon, Catherine M.

doi:10.1148/radiol.11110358

Cited by 57 publications

(23 citation statements)

References 48 publications

(48 reference statements)

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“…71 Despite the high prevalence of vitamin D insufficiency in infants and toddlers, rickets is uncommon. 72 The claim that vitamin D deficiency or insufficiency causes skeletal lesions that lead to the incorrect diagnosis of child abuse in infants is not supported in the literature. A systematic clinical, laboratory, and radiologic assessment should exclude that possibility.…”

Section: Vitamin D Deficiency Ricketsmentioning

confidence: 99%

“…In this population, the reported fracture prevalence was zero. 72 In a study of 45 young children with radiographic evidence of rickets, investigators found that fractures occurred only in those infants and toddlers who were mobile. 77 Fractures were seen in 17.5% of the children, and these children were 8 to 19 months of age.…”

Section: Vitamin D Deficiency Ricketsmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

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247

162

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Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures. Pediatrics 2014;133:e477-e489 INTRODUCTIONFractures are the second most common injury caused by child physical abuse; bruises are the most common injury. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 2-4 Physical abuse may not be considered in the physician' s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. DIFFERENTIAL DIAGNOSIS OF FRACTURES Trauma: Child Abuse Versus Noninflicted InjuriesFractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. [6][7][8] In infants and toddlers, physical FROM THE AMERICAN ACADEMY OF PEDIATRICSGuidance for the Clinician in Rendering Pediatric Care by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from abuse is the cause of 12% to 20% of fractures. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 10,11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the hist...

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Section: Vitamin D Deficiency Ricketsmentioning

confidence: 99%

Section: Vitamin D Deficiency Ricketsmentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

Self Cite

247

162

View full text Add to dashboard Cite

show abstract

“…Perez-Rossello et al identified 26 children with radiographic and biochemical evidence of rickets. At telephone interview follow-up 2-3 years after diagnosis and treatment, no child had sustained a fracture [53]. However, owing to the small number of children included and lack of a healthy control group, it is difficult to draw any conclusions on fracture risk following resolution of rickets.…”

Section: Fracture In Children With Vitamin D Deficiency Ricketsmentioning

confidence: 99%

Vitamin D and skeletal health in infancy and childhood

et al. 2014

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During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High quality randomised trials are now required to confirm this benefit.

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“…However, this paper did not address causality between low vitamin D levels, without the presence of radiological findings, and fracture risk. A study from Perez-Rosello et al did show that in children with proven low vitamin D-levels and normal skeletal surveys no increase in fracture incidence was noted [6]. Based on their findings the authors concluded that 'In infants and toddlers with vitamin D deficiency, rachitic changes and definite demineralization are uncommon and fracture risk is low'.…”

Section: Dear Editormentioning

confidence: 97%