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

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 os...

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Bibliographic Details
Published in:Pediatric emergency care Vol. 37; no. 10; pp. e636 - e639
Main Authors: Goldner, Dana, Vittorio, Jennifer, Barrios, Dulce M., McGuire, Jillian, Brodlie, Susan, Brown, Jocelyn, Lobritto, Steven, Martinez, Mercedes
Format: Journal Article
Language:English
Published: United States Lippincott Williams & Wilkins 01-10-2021
Copyright Wolters Kluwer Health, Inc. All rights reserved
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Summary: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.
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ISSN:0749-5161
1535-1815
DOI:10.1097/PEC.0000000000001740