• Pediatric emergency care · Oct 2021

    Bone Fractures in Children With Cholestatic Liver Disease May Mimic Those Seen in Child Abuse.

    • Dana Goldner, Jennifer Vittorio, Dulce M Barrios, Jillian McGuire, Susan Brodlie, Jocelyn Brown, Steven Lobritto, and Mercedes Martinez.
    • From the Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York.
    • Pediatr Emerg Care. 2021 Oct 1; 37 (10): e636e639e636-e639.

    AbstractCertain fractures in children are highly specific for child abuse. Metabolic bone disease frequently develops in patients with cholestatic liver disease (CLD); this can result in weakened bones and a predisposition to pathologic fractures. Fractures that occur in patients with rickets and osteopenia may mimic a bone response to inflicted injury, which in children raise the concern of child abuse. Here we report a series of 15 patients with CLD who developed pathologic fractures in the setting of metabolic bone disease. During initial evaluation, the caretakers of 5 of these 15 patients were reported to child protective services and investigated for child abuse. Pediatricians should be aware that children with CLD have an increased incidence of pathologic fractures, even after the cholestasis has resolved.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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