title: Vitamin D status in abused and nonabused children younger than 2 years old with fractures.
abstract: OBJECTIVE
  To examine vitamin D levels in children with (1) suspected abusive and accidental fractures, (2) single and multiple fractures, and (3) fracture types highly associated with inflicted trauma.
  
  
  METHODS
  A study of children younger than 2 years of age with fractures admitted to a large children's hospital was performed. Bivariate analysis and test for trend were performed to test for the association of vitamin D status and biochemical markers of bone health with the primary outcomes of fracture etiology, number, and type.
  
  
  RESULTS
  Of 118 subjects in the study, 8% had deficient vitamin D levels (<20 ng/mL; <50 nmol/L), 31% were insufficient (≥20 < 30 ng/mL; ≥50 < 78 nmol/L), and 61% were sufficient (≥30 ng/mL; ≥78 nmol/L). Lower vitamin D levels were associated with higher incidences of hypocalcemia (P = .002) and elevated alkaline phosphatase (P = .05) but not hypophosphatemia (P = .30). The majority of children sustained accidental fractures (60%); 31% were nonaccidental and 9% were indeterminate. There was no association between vitamin D levels and any of the following outcomes: child abuse diagnosis (P = .32), multiple fractures (P = .24), rib fractures (P = .16), or metaphyseal fractures (P = .49).
  
  
  CONCLUSIONS
  Vitamin D insufficiency was common in young children with fractures but was not more common than in previously studied healthy children. Vitamin D insufficiency was not associated with multiple fractures or diagnosis of child abuse. Nonaccidental trauma remains the most common cause of multiple fractures in young children.
authors.affiliation: The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA. schillings@email.chop.edu
authors.forename: Samantha
authors.initials: S
authors.lastname: Schilling
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Wood
authors.forename: Michael A
authors.initials: MA
authors.lastname: Levine
authors.forename: David
authors.initials: D
authors.lastname: Langdon
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Christian
mesh_terms: D015519:Bone Density / Q000502:physiology; D016022:Case-Control Studies; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology; D009752:Nutritional Status; D012016:Reference Values; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014808:Vitamin D Deficiency / Q000175:diagnosis* / Q000453:epidemiology*