Rickets An Epidemic

Rickets Vs Abuse: A National And International Epidemic

Kathy A Keller

Patrick D Barnes

In summary, in infants less than 6 months of age with
multiple asymptomatic metaphyseal lesions (particularly
along the medial aspect of the distal femurs and proximal
tibiae as well as in the distal tibiae and fibulae), pseudodiastasis
of the sutures, transverse lucencies through the
forearms and ribs, and compression fractures of the spine
should alert the radiologist to the possibility of osteomalacia
with early metaphyseal changes, insufficiency fractures
and Looser zones. Clinical correlation is important, as most
of these lesions are asymptomatic both at presentation and
historically. With documentation of DD, 2 week follow-up
radiographs may identify metaphyseal lesions that are
resolving at an accelerated rate without interval subperiosteal
new bone, callus or remodeling. While concomitant
nonaccidental injury should never be excluded from the
differential, it goes without saying that the suspicion or
presence of abuse should not preclude the diagnosis and
treatment of DD. With subclinical DD being reported at such
high prevalences, the radiologists’ attention to these metabolic
changes on radiographs will provide valuable input to
help promote improvement in the vitamin D status of
pregnant women and their newborn infants.

Source:

http://www.stanford.edu/~pbarnes/docs/publications/Rickets_Abuse.pdf

Reply Regarding Rickets Vs Abuse:  The Evidence

Kathy A Keller

Patrick D Barnes

Sept 1, 2009

Abstract:

In conclusion, we propose that:

(1) Maternal-fetal and
neonatal vitamin D deficiency (DD) exists and is increasing.

(2) DD can produce imaging abnormalities prior to the
classic changes of rickets and predispose the infant to
“fractures.”

(3) The imaging findings of rickets are different
in infants younger than 6 months of age compared to older
infants.

(4) These findings can mimic abuse (e.g., CMLs).

(5) Infants with bone imaging findings suggestive of abuse
should also have vitamin D level determinations.

(6)
Radiologists should provide a differential diagnosis when
faced with bone imaging findings suggestive of abuse.

(7)The significance of the imaging findings must always be
considered in the context of the clinical, social, and
biochemical aspects of the case.

(8) It should be possible
to collect reliable data (imaging findings, vitamin D levels,
BMD) and test these hypotheses.

Source:

http://www.stanford.edu/~pbarnes/docs/publications/NAI-Reply.pdf