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Published on: August 17, 2017
Fetal bone loading is a critical determinant of fetal and young infant bone strength
1Emeritus Professor of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
Insights
Metabolic Bone Disease of Infancy, a cause of infant fractures, stems from fetal bone fragility risk factors. Decreased fetal movement is a key factor, leading to poor bone mineralization that can mimic child abuse.
Area of Science:
- Pediatric Bone Health
- Forensic Pediatrics
- Neonatal Physiology
Background:
- The Utah Paradigm models bone physiology and identifies risk factors for bone fragility.
- It aids in evaluating infants with unexplained fractures in suspected child abuse cases.
Purpose of the Study:
- To apply the Utah Paradigm to the fetal period.
- To identify risk factors for bone fragility in infants with unexplained fractures.
Main Methods:
- Analysis of over 500 contested child abuse cases involving infants with multiple unexplained fractures.
- Application of the Utah Paradigm to the fetal period.
Main Results:
- Identified risk factors for fetal bone fragility include maternal nutrient deficiency, prematurity, gestational diabetes, and drug exposure.
- Decreased fetal bone loading due to reduced fetal movement was the most common risk factor.
- Multiple risk factors can co-exist, leading to Metabolic Bone Disease of Infancy (MBDI).
Conclusions:
- MBDI must be considered in infants with unexplained fractures.
- Diagnosis involves X-rays showing poor bone mineralization and identified risk factors.
- Fetal bone loading is critical; reduced fetal movement compromises infant bone strength.
Background:
The Utah Paradigm is the contemporary model of bone physiology that allows for an understanding of risk factors for bone fragility and can be used in understanding infants who present with multiple unexplained fractures in contested cases of child abuse.
Method:
The Utah Paradigm was applied to the fetal period in over 500 cases of contested child abuse cases in infants with multiple unexplained fractures to determine if risk factors for bone fragility could be identified.
Findings:
Multiple risk factors for fetal bone fragility were identified: inadequate provision by the mother during pregnancy of essential bone nutrients (calcium, phosphate, vitamin D, and protein), prematurity, gestational diabetes, and fetal exposure to drugs that can affect bone strength. The most common risk factor was decreased fetal bone loading from decreased fetal movement. More than one risk factor was often identified in these cases, and the term Metabolic Bone Disease of Infancy is used to describe this multifactorial bone fragility disorder of young infants. Infants with Metabolic Bone Disease of Infancy have X-rays that show poor bone mineralization, and this condition can be misdiagnosed as child abuse.
Interpretation:
Metabolic Bone Disease of Infancy should be considered in infants with multiple unexplained fractures. This condition can be established by finding abnormal X-rays showing poor bone mineralization and risk factors for bone fragility. Fetal bone loading is the most critical determinant of fetal and young infant bone strength. Situations that cause decreased fetal movement can casue decreased fetal and young infant bone strength.
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