{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:03:28Z","timestamp":1791655408959,"version":"4.3.4"},"reference-count":81,"publisher":"Walter de Gruyter GmbH","issue":"10","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpem-2019-0093_s_999_w2aab3b7b5b1b6b1aab1c18b1Aa\">\n                    <jats:title id=\"d2761551e12684_w2aab3b7b5b1b6b1aab1c18b1aAa\">Background<\/jats:title>\n                    <jats:p>Infants who present with multiple unexplained fractures (MUF) are often diagnosed as victims of child abuse when parents deny wrongdoing and cannot provide a plausible alternative explanation. Herein we describe evidence of specific and commonly overlooked radiographic abnormalities and risk factors that suggest a medical explanation in such cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpem-2019-0093_s_998_w2aab3b7b5b1b6b1aab1c18b2Aa\">\n                    <jats:title id=\"d2761551e12692_w2aab3b7b5b1b6b1aab1c18b2aAa\">Methods<\/jats:title>\n                    <jats:p>We evaluated such infants in which we reviewed the radiographs for signs of poor bone mineralization. We reviewed medical, pregnancy and family histories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpem-2019-0093_s_997_w2aab3b7b5b1b6b1aab1c18b3Aa\">\n                    <jats:title id=\"d2761551e12700_w2aab3b7b5b1b6b1aab1c18b3aAa\">Results<\/jats:title>\n                    <jats:p>Seventy-five of 78 cases showed poor bone mineralization with findings of healing rickets indicating susceptibility to fragility fractures that could result from a wide variety of causes other than child abuse. We found risk factors that could explain the poor bone mineralization: maternal and infant vitamin D deficiency (VDD), decreased fetal bone loading, prematurity and others. Most infants had more than one risk factor indicating that this bone disorder is a multifactorial disorder that we term metabolic bone disease of infancy (MBDI). Maternal and infant VDD were common. When tested, 1,25-dihydroxyvitamin D levels were often elevated, indicating metabolic bone disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpem-2019-0093_s_996_w2aab3b7b5b1b6b1aab1c18b4Aa\">\n                    <jats:title id=\"d2761551e12708_w2aab3b7b5b1b6b1aab1c18b4aAa\">Conclusions<\/jats:title>\n                    <jats:p>Child abuse is sometimes incorrectly diagnosed in infants with MUF. Appreciation of the radiographic signs of MBDI (healing rickets), risk factors for MBDI and appropriate laboratory testing will improve diagnostic accuracy in these cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpem-2019-0093","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T05:02:40Z","timestamp":1570683760000},"page":"1103-1120","source":"Crossref","is-referenced-by-count":33,"title":["Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants"],"prefix":"10.1515","volume":"32","author":[{"given":"Marvin","family":"Miller","sequence":"first","affiliation":[{"name":"Dayton Children\u2019s Hospital, Department of Medical Genetics , 1 Children\u2019s Plaza , Dayton, OH 45404 , USA"},{"name":"Department of Pediatrics, Ob\/Gyn and Biomedical Engineering , Wright State University Boonshoft School of Medicine , Dayton, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne","family":"Stolfi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Wright State University Boonshoft School of Medicine , Dayton, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Clinical Radiologists, SC , Springfield, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2019,10,10]]},"reference":[{"key":"2023040101010088592_j_jpem-2019-0093_ref_001_w2aab3b7b5b1b6b1ab1b8b1Aa","unstructured":"Flaherty EG, Perez-Rossello JM, Levine MA, Hennrikus WL, American Academy of Pediatrics Committee on Child Abuse and Neglect. Evaluating children with fractures for child physical abuse. Pediatrics 2014;133:e477\u201389.2447064210.1542\/peds.2013-3793"},{"key":"2023040101010088592_j_jpem-2019-0093_ref_002_w2aab3b7b5b1b6b1ab1b8b2Aa","doi-asserted-by":"crossref","unstructured":"Ayoub D, Hyman C, Cohen M, Miller M. A critical review of the classic metaphyseal lesion (CML): traumatic or metabolic? AJR Am J Roentgenol 2014;202:185\u201396.10.2214\/AJR.13.10540","DOI":"10.2214\/AJR.13.10540"},{"key":"2023040101010088592_j_jpem-2019-0093_ref_003_w2aab3b7b5b1b6b1ab1b8b3Aa","doi-asserted-by":"crossref","unstructured":"Miller ME, Mirkin LD. Classical metaphyseal lesions thought to be pathognomonic of child abuse are often artifacts or indicative of metabolic bone disease. 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