Non-accidental injury: confusion with temporary brittle bone disease and mild osteogenesis imperfecta

Accurate diagnosis of non-accidental injury (NAI) can be reached in the majority of cases by careful appraisal of the social and family history, combined with painstaking clinical roentgenographic and other imaging evaluations. Careful review of the scientific literature clearly indicates that collagen analysis to exclude mild forms of osteogenesis imperfecta, especially type IV, is recommended only in rare cases in which diagnosis of NAI remains in doubt even after thorough evaluation by experienced radiologists and/or other physicians. Until clinical research scientifically establishes the existence of temporary brittle bone disease, it should remain strictly a hypothetical entity and not an acceptable medical diagnosis.