Vitamin D deficiency may contribute to fractures in children and should not be ruled out as a potential cause. The study found vitamin D deficiency in 8% of children with fractures, but criteria for identifying abuse included failure of parents to explain fractures, which could include cases caused by vitamin D deficiency. Additionally, radiologic signs of rickets may be absent even with severe biochemical deficiency. Vitamin D deficiency may cause pseudofractures that could be mistaken for abuse, so it should continue to be considered in cases of unexplained fractures in children.
3. One factor that contributes to the dis- is not growing. For similar reasons, just 10 were evaluated by the meta-
crepancy between radiology and bio- the serum alkaline phosphatase level bolic bone service. This may well be a
chemistry is the phenomenon known is often inappropriately normal in chil- better proportion than in other cen-
to earlier pediatricians as the “para- dren who are not growing.24 ters, but is it good enough? One lesson
dox of rickets.”23 As the deficiency There is another concern that is high- from the recent literature is that frac-
worsens, the epiphyseal changes be- lighted by Schilling et al in their article: tures in childhood, including metaphy-
come less obvious. The classical radio- of 118 children with fractures, includ- seal fractures, have a substantial dif-
logic signs are not seen in a child who ing 37 thought to have been abused, ferential diagnosis.
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4. Vitamin D Deficiency and Fractures in Childhood
Colin R. Paterson
Pediatrics published online Apr 11, 2011;
DOI: 10.1542/peds.2011-0086
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