Vitamin D deficiency and fractures in childhood.

One difficulty with this logic is that included in the criteria for identifying abuse was the failure of the parents to explain the fractures. Although the lack of an explanation may be a pointer to nonaccidental injury, it is also a characteristic feature of fractures caused by bone diseases such as osteogenesis imperfecta, bone disease of prematurity, and, indeed, rickets.4 Thus, the criteria for abuse could include patients whose fractures were actually caused by vitamin D deficiency.