Temporary brittle bone disease: Fractures in medical care
Acta Pediatrica, Exclusive Author Commentary

Paterson CR et al. – This study reports 5 infants with typical features of temporary brittle bone disease in whom all or most of the fractures took place while in hospital. A non-accidental cause can be eliminated with some confidence. These findings are important in contributing to the evidence for the reality of a syndrome characterized by temporary bone fragility and should stimulate increased effort to identify the causes.

  • What is the nature of this condition?
    • One possibility is osteogenesis imperfecta. However it seems unlikely, as it should have shown other good evidence for its existence
    • Another possibility is vitamin D deficiency rickets, which is now recognized as much more common than previously thought
    • Another possibility, at least in one case, is bone disease of prematurity
    • Various metabolic and mechanical causes for this syndrome have also been reported
    • One feature of this group of pts is the very large number of rib fractures which occurred under close medical supervision and without any other evidence of trauma

One difficulty with temporary brittle bone disease is that it would have been recognised as a distinctive diagnosable entity years ago but for the fact that its characteristic features have been confidently ascribed to non-accidental injury for about forty years. Some writers assert that the condition does not exist and is simply misdiagnosed child abuse. However, the current paper is part of the evidence that it is a distinct disorder. Other lines of evidence include the consistency of the clinical and radiological findings, the regular lack of physical evidence of injury commensurate with the x-ray findings and the fact that when, against the odds, children with this diagnosis are returned to their parents no subsequent evidence of abuse has been found. Further papers are in preparation on these issues.

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