25-OH Vitamin D Deficiency Does Not Significantly Predispose Young Children to Multiple Fractures from Minimal Trauma.

Background: In the absence of significant accidental trauma, the identification of multiple fractures in a young child raises concern for abuse. One group has suggested that there is an unrecognized "epidemic" of 25-OH vitamin D deficiency that produces findings frequently mistaken for child abuse.

Objective: Test whether 25-OH vitamin D deficiency predisposes young children to fractures.

Participants and setting: Children <5 years old with blood obtained during acute trauma care at a large, regional pediatric center.

Methods: This cross-sectional study compared the number of fractures in children with 25-OH Vitamin D deficiency to those with sufficient levels.

Results: Among 656 eligible participants, 25-OH vitamin D levels were obtained in 203 (31%). Using a threshold of 20 ng/mL, 35 (17%) participants were found to have 25-OH vitamin D deficiency. Among children with deficiency, 19/35 (54%) had at least one fracture, compared to 97/168 (58%) of those with sufficiency (p=0.712). Among those with fractures, the mean number of fractures was 2.9 for sufficient children and 3.2 for deficient children (p=0.70). Fourteen children had five or more fractures, including 11 with physical abuse, and 3 with severe accidental trauma. Among 35 children with deficiency, 17 (49%) were reported to Child Protective Services, compared to 62/168 (37%) with sufficiency (OR 1.62, 95%CI 0.78-3.36) CONCLUSION: 25-OH vitamin D deficiency in the absence of significant trauma is not a plausible explanation for multiple fractures.

Type of study: Prospective, Cross-sectional Study LEVEL OF EVIDENCE: III.