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Skeletal Radiology

, Volume 49, Issue 1, pp 85–91 | Cite as

Rachitic change and vitamin D status in young children with fractures

  • Sabah ServaesEmail author
  • Lisa States
  • Joanne Wood
  • Samantha Schilling
  • Cindy W. Christian
Scientific Article

Abstract

Objective

To examine the association between rachitic changes and vitamin D levels in children less than 2 years old with fractures.

Methods

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.

Results

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.

Conclusions

Infants and toddlers with fractures frequently have suboptimal vitamin D levels, but radiographic evidence of rickets is uncommon in these children.

Keywords

Vitamin D deficiency Rickets Child abuse 

Notes

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.

References

  1. 1.
    Chapman T, Sugar N, Done S, Marasigan J, Wambold N, Feldman K. Fractures in infants and toddlers with rickets. Pediatr Radiol. 2010;40(7):1184–9.CrossRefGoogle Scholar
  2. 2.
    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.CrossRefGoogle Scholar
  3. 3.
    Mansbach JM, Ginde AA, Camargo CA Jr. Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics. 2009;124(5):1404–10.CrossRefGoogle Scholar
  4. 4.
    Gordon CM, Feldman HA, Sinclair L, et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med. 2008;162(6):505–12.CrossRefGoogle Scholar
  5. 5.
    Paterson CR. Vitamin D deficiency rickets and allegations of non-accidental injury. Acta Paediatr. 2009;98(12):2008–12.CrossRefGoogle Scholar
  6. 6.
    Schilling S, Wood JN, Levine MA, Langdon D, Christian CW. Vitamin D status in abused and nonabused children younger than 2 years old with fractures. Pediatrics. 2011;127(5):835–41.CrossRefGoogle Scholar
  7. 7.
    Perez-Rossello JM, Feldman HA, Kleinman PK, et al. Rachitic changes, demineralization, and fracture risk in healthy infants and toddlers with vitamin D deficiency. Radiology. 2012;262(1):234–41.CrossRefGoogle Scholar
  8. 8.
    Swischuk LE, Hayden CKJ. Seizures and demineralization of the skull. A diagnostic presentation of rickets. Pediatr Radiol. 1977;6(2):65–7.CrossRefGoogle Scholar
  9. 9.
    Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Manaster BJ, Reading JC. Radiographic scoring method for the assessment of the severity of nutritional rickets. J Trop Pediatr. 2000;46(3):132–9.CrossRefGoogle Scholar
  10. 10.
    Misra M, Pacaud D, Petryk A, Collett-Solverg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398–417.CrossRefGoogle Scholar
  11. 11.
    Ryan LM, Teach SJ, Singer SA, et al. Bone mineral density and vitamin D status among African American children with forearm fractures. Pediatrics. 2012;130(3):e553–60.CrossRefGoogle Scholar
  12. 12.
    Keller KA, Barnes PD. Rickets vs. abuse: a national and international epidemic. Pediatr Radiol. 2008;38(11):1210–6.CrossRefGoogle Scholar
  13. 13.
    Strouse PJ. Keller & Barnes' after 5 years - still inadmissible as evidence. Pediatr Radiol. 2013;43(11):1424.CrossRefGoogle Scholar

Copyright information

© ISS 2019

Authors and Affiliations

  • Sabah Servaes
    • 1
    Email author
  • Lisa States
    • 1
  • Joanne Wood
    • 2
  • Samantha Schilling
    • 3
  • Cindy W. Christian
    • 2
  1. 1.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Department of PediatricsUniversity of North CarolinaChapel HillUSA

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