Letter to the Editor in Response to: 25-OH Vitamin D Deficiency Does Not Significantly Predispose Young Children to Multiple Fractures From Minimal Trauma

jpedsurg.org

I read the article by Dyba et al., 25-OH Vitamin D Deficiency Does Not Significantly Predispose Young Children to Multiple Fractures from Minimal Trauma [1], with interest. The authors conclude that low Vitamin D levels in children up to 5 years old are not associated with findings that mimic abuse. However, this conclusion may overlook a potential signal in the subgroup most relevant to this question: infants under 6 months of age. This age group is central to the ongoing debate regarding misdiagnosis of abuse in the presence of bone fragility.

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Article · Apr 2025 · 1 min read

In brief

This letter critiques a study concluding that vitamin D deficiency does not predispose young children to multiple fractures mimicking abuse. The author argues the analysis may miss important findings in infants under 6 months, the age group most relevant to debates about misdiagnosis of abuse versus bone fragility.

Low vitamin D levels in children ≤5 years may not be associated with fracture patterns mimicking abuse, per Dyba et al.
Infants <6 months—the age group most relevant to abuse vs. bone fragility debates—warrant separate subgroup analysis.
The study's broad age range may obscure age-specific vitamin D effects on fracture risk in very young infants.
Clinicians should interpret vitamin D findings cautiously when differentiating accidental trauma from non-accidental injury.
Further research isolating infants <6 months is needed to clarify vitamin D's role in fractures that mimic abuse.

Written by the GCMD Library team from the article.

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