Gopal-Kothandapani, J.S.

Offiah, A.C.

Pang, E.

Sprigg, A.

White Rose Research Online

This is a repository copy of Unexplained Fractures In Infants And Young Children: (Ir)Relevance Of Serum Vitamin D.White Rose Research Online URL for this paper:http://eprints.whiterose.ac.uk/127653/Version: Accepted VersionProceedings Paper:Gopal-Kothandapani, J.S., Pang, E., Sprigg, A. et al. (1 more author) (2017) Unexplained Fractures In Infants And Young Children: (Ir)Relevance Of Serum Vitamin D. In: Hormone Research in Paediatrics. 10th Individual Abstracts for International Meeting of Pediatric Endocrinology, 14-17 Sep 2017, Washington D.C.. , s442-s443. eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. 23/03/2016, 15:17RSNA 2016Page 1 of 3http://abstract.rsna.org/index.cfm?fuseaction=submission.popupPreview&em_id=16003793&am_id=6&ptt_id=9Submission Type: Scientific PresentationsContact: Amaka C Offiah MBBS,PhDINSTITUTION: University of Sheffield Department of Oncology and MetabolismE-Mail: a.offiah@sheffield.ac.ukPrimary Category: Pediatrics Only Secondary Category: MusculoskeletalUnexplained Fractures in Infants and Young Children: (Ir)relevance of Serum Vitamin DE Pang; S Gopal; A Sprigg, MBChB, FRCR; A C Offiah, MBBS,PhD, Sheffield, UNITED KINGDOM(a.offiah@sheffield.ac.uk)PURPOSETo test the hypothesis that low serum total 25-hydroxyvitamin D (VitD) predisposes children aged ≤2years tofractures, even when there is no overt rickets. METHOD AND MATERIALSA retrospective single centre study. The hospital database was interrogated for children ≤2years who had VitDmeasured between 01/01/10 and 12/31/14 AND at least 1 skeletal radiograph within 2 weeks of this. Blindedto VitD, 2 observers independently scored the anonymised full skeletal surveys (SS) and individualradiographs (XR) for fracture (yes/no), bone density (reduced/normal) and rickets (Thacher score 0/≥1).Discrepancies were arbitrated by a third observer in a final consensus read. Analyses (SPSS V22.0 for Mac, p≤ 0.05) included descriptive statistics (prevalence of clinical and radiographic parameters), Cohen’s kappa(interobserver reliability for radiographic parameters) and binomial logistic regression (likelihood of fracturebased on VitD, bone density or Thacher score). Further analyses (calcium/phosphate/ethnicity/breast fed) areon-going. Research and Development approval was granted; Ethics Committee approval was waived. RESULTS388 children, mean age 9 months (0-24), 167 SS and 239 XR were included. Mean VitD was 67nmol/L (<6-778nmol/L); 77 children (20%) were VitD deficient (≤25nmol/L); 78 (20%) insufficient (25.1-50nmol/L); 69(18%) had at least one fracture; 39 (10%) reduced bone density; 22 (6%) Thacher ≥1. Interobserver kappawas very high for fracture (0.915) and Thacher score (0.842) and good for bone density (0.706). Logisticregression (Table) showed that radiographic bone density was the only statistically significant variablepredictive of presence of fracture, with an odds ratio of 4.61 (95%CI 2.05-10.38). The odds ratio for VitD levelwas 1.02 (0.99-1.06). CONCLUSIONObserver reliability for diagnosing reduced bone density and rickets from radiographs ranges from good tovery high. This study provides objective evidence to support mainstream thinking that in the absence ofradiographic evidence of reduced bone density and/or rickets, a low vitD should not be interpreted as thecause of unexplained fractures in a child below 2 years of age. CLINICAL RELEVANCE/APPLICATIONIn children aged ≤2years with unexplained fractures, whose radiographs reveal normal bone density and/or aThacher score of zero, serum VitD level is irrelevant to the etiology of the fractures. FIGURE (OPTIONAL)Uploaded ImageView Larger Image 23/03/2016, 15:17RSNA 2016Page 2 of 3http://abstract.rsna.org/index.cfm?fuseaction=submission.popupPreview&em_id=16003793&am_id=6&ptt_id=9Disclosures:Nothing to disclose: Elaine Pang Nothing to disclose: Sujatha Gopal Nothing to disclose: Alan Sprigg 1. Honoraria/Travel Support: Alexion Pharmaceuticals Inc, BioMarinPharmaceutical Inc, Infomed Research and Training Ltd 2. Director, OCINLtdAmaka Offiah Questions:1.Published email: Do you wish to have an email address published in the RSNA program?YesIf yes, please provide one email address:a.offiah@sheffield.ac.uk2.Previously Presented/Published: The RSNA requires that all abstracts submitted for scientific presentationbe original work, not previously presented at other national or international radiological society meetings* andnot previously published. An abstract which includes an increased number of cases with a new analysis of thedata and additionally demonstrates a significant change in results is considered new research; therefore, suchwork is eligible for consideration.  If an abstract merely reflects an increase in the number of cases with nosignificant difference in the results, it will not be considered. (See General Information >Policy on PreviousPublication or Presentation)  *An exception has been made for work previously presented at certain closed radiology subspecialtymeetings. Click here  to view a list of approved closed meetings. If your RSNA abstract is based on workpresented at one the closed meetings listed, you must respond YES to the question and indicate the name ofthe event in the field below.   Has this work been previously presented or published? NoIf Yes, please indicate where previously published or presented and specify if the current results aresubstantially different. PLEASE NOTE, if the work--or a substantial part of it--has been previously presentedor published, the presenter must discuss with the Chairman of the Scientific Program Committee theacceptability of submitting this same work to the RSNA. Send inquiries to programs@rsna.org. No response3.Disclosure of "Off-Label" usage: The RSNA recognizes the authors may discuss the application of devices,materials, or pharmaceuticals that are not FDA approved for the discussed application. In keeping with thehighest standards of professional integrity and ethics, the RSNA requires full disclosure of the discussion ofthe unlabeled use of a medical device, product, or pharmaceutical that has not been approved by FDA.Please mark the appropriate response below as to whether you or any of your co-authors will or will notdescribe the investigational or "Off-label" use of a medical device, product or pharmaceutical that is classifiedby the FDA as investigational for the intended use. If you or any of your co-authors will discuss or describeinvestigational or unlabeled products, the presenting author is responsible for disclosing the information to theaudience.No, I do not intend to discuss off-label uses4.Format Preference: Accepted scientific presentation abstracts will be scheduled in the following formats atthe discretion of the subspecialty chair. While consideration will be given to your indicated preference,decisions on format assignment will be based on the needs of the program. All decisions are final.23/03/2016, 15:17RSNA 2016Page 3 of 3http://abstract.rsna.org/index.cfm?fuseaction=submission.popupPreview&em_id=16003793&am_id=6&ptt_id=9[Reminder--Presenters of oral paper presentations have the option to submit a second presentation inelectronic, slide show format (40 slides max). Content is due by early November and will be on display for theduration of the RSNA Annual Meeting via the RSNA Digital Presentation System.Please indicate your format preference for a paper or poster presentation below.Oral paper5.Travel Award Program for Students: Up to 400 top-rated abstracts from current RSNA members will earn a$500 travel stipend through the RSNA Travel Award Program. To be eligible for the award, you must be one ofthe following (eligibility requirements for the award can be viewed under General Information>Awards):Not Applicable6.Trainee Research Prize: If you are interested in the Research or Medical Student award, the principalinvestigator and presenter must be the same. Non-imaging trainees are eligible if they are mentored by amember of the RSNA, AAPM, or ASTRO.  If accepted for presentation, the author will receive a letter ofinvitation to submit a more detailed abstract for consideration of the Trainee Research Prize. Please checkbelow:Not Applicable7.Has this work been funded by National Institutes of Health (NIH)?No8.Do you anticipate that the results of your research are highly likely to change patient management in the nearfuture? (Eligible for High Impact Clinical Trials session)Yes

Unexplained Fractures In Infants And Young Children: (Ir)Relevance Of Serum Vitamin D

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Unexplained Fractures In Infants And Young Children: (Ir)Relevance Of Serum Vitamin D

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