Rachitic change and vitamin D status in young children with fractures
To examine the association between rachitic changes and vitamin D levels in children less than 2 years old with fractures.
Children less than 2 years old who were admitted to a large children’s hospital for a fracture and underwent a skeletal survey were included. Two pediatric radiologists blinded to the children’s vitamin D levels independently reviewed the skeletal surveys for the following rachitic findings: demineralization, widened sutures, rachitic rosary, Looser zones, and metaphyseal changes. Kappa coefficients were calculated to assess inter-rater agreement. Logistic regression was used to test the association between vitamin D level and rachitic findings.
There were 79 subjects (40 female and 39 male) with a median age of 4 months. Vitamin D levels ranged from 11.6 to 88.9 ng/ml and were low in 27. Questionable demineralization was noted in seven subjects; mild to moderate demineralization was observed in four subjects. Widened sutures were noted in seven subjects, many also with concurrent intracranial hemorrhage. Lower vitamin D levels were associated with increased odds of demineralization after adjusting for age, gender, and prematurity (P < 0.015). An association was not found between the vitamin D level and suture widening (P = 0.07). None of the cases demonstrated Looser zones, rachitic rosary, or metaphyseal changes of rickets.
Infants and toddlers with fractures frequently have suboptimal vitamin D levels, but radiographic evidence of rickets is uncommon in these children.
KeywordsVitamin D deficiency Rickets Child abuse
Compliance with ethical standards
Conflict of interest
Four of the authors provide expert testimony for child abuse cases. Three of them receive no compensation for this activity, but one (Dr. Christian) has received compensation.