Calciferol Deficiency Mimicking Abusive Fractures in Infants: Is There Any Evidence?

The history of calciferol^∗ metabolism and biochemistry is tightly intertwined with that of American pediatrics. Rickets was a widespread affliction of children in urban areas in the 19th and early 20th centuries. Mellanby recognized the anti-rachitic properties of a fat-soluble substance that was incorrectly named “vitamin” D. Shortly thereafter, Eliot undertook a seminal clinical trial in New Haven that demonstrated the ability of cod-liver oil to prevent rickets in infants. Within decades, supplementation of nursing infants became nearly universal, and clinical rickets largely disappeared. In the latter part of the 20th century, lax prescribing of calciferol supplements to nursing children, combined with an increasing number of mothers of darkly pigmented infants choosing to breast feed, led to a resurgence of clinical rickets.¹

25(OH)D, 25-hydroxycholecalciferol, 1,25(OH)2D, 1,25-hydroxycholergocalciferol, PTH, Parathyroid hormone