Long-term follow-up of children thought to have temporary brittle bone disease

Abstract

Background:

In addition to nonaccidental injury, a variety of bone disorders may underlie the finding of unexplained fractures in young children. One controversial postulated cause is temporary brittle bone disease, first described in 1990.

Methods:

Eighty-five patients with fractures showing clinical and radiological features of temporary brittle bone disease were the subject of judicial hearings to determine whether it was appropriate for them to return home. Sixty-three patients did, and follow-up information was available for 61 of these. The mean follow-up period was 6.9 years (range 1–17, median 6).

Results:

We found that none of the children had sustained any further injuries that were thought to represent nonaccidental injury; no child was re-removed from home. Three children had fractures. In each case there was general agreement that the fractures were accidental. Had the original fractures in these children been the result of nonaccidental injury, it would have been severe and repeated; the average number of fractures was 9.1.

Conclusion:

The fact that no subsequent suspicious injuries took place after return home is consistent with the view that the fractures were unlikely to have been caused by nonaccidental injury, and that temporary brittle bone disease is a distinctive and identifiable disorder.

Keywords::

• fractures
• osteogenesis imperfecta
• temporary brittle bone disease
• nonaccidental injury