Occult bone disease in sudden childhood death: A post-mortem study
Research type
Research Study
Full title
Prevalence of occult bone disease due to vitamin D deficiency in sudden unexpected death in childhood: A post-mortem study.
IRAS ID
207267
Contact name
Suma Uday
Contact email
Sponsor organisation
Birmingham Children's Hospital
Duration of Study in the UK
7 years, 4 months, 31 days
Research summary
Vitamin D deficiency is common in the UK. Long standing deficiency can cause bone disease called rickets in children. Rickets is associated with soft bones (osteomalacia), low bone strength and fractures and diagnosed on x-rays. However, changes in bone structure and mineral deposition precede X-ray changes. We have previously determined the level of vitamin D (25OHD) at which blood markers of rickets appear, however we have little understanding what level of vitamin D softens bone at the tissue level before X-rays become abnormal. A small UK post-mortem (PM) study has shown that occult (undiagnosed) bone tissue changes were noted in 59% of vitamin D deficient infants, which may be relevant given that the cause of death remains unexplained in 60% of cases with sudden infant death. From PM studies we know than 1 in 4 adults has osteomalacia. We conduct this study to
1. Identify the role of occult vitamin D deficiency in childhood deaths.
2. Understand the prevalence of occult rickets and osteomalacia in children to inform preventative public health interventions, and build evidence for courts investigating suspected child abuse where fractures are attributed to vitamin D deficiency.
Our study will be the first to determine the true impact of vitamin D deficiency on the paediatric population by assessing the prevalence of occult osteomalacia and rickets.The following information will be collected over 2 years and studied in relation to serum 25OHD in 120 children at routine Coroner’s PM at Birmingham Women’s Hospital:
Microscopic changes in the growing part of the rib, bone x-rays and weight and size of the heart (all routinely done at PM).
Bone strength on mechanical testing performed on a small piece (4 cm) of rib bone routinely extracted.
Signs of osteomalacia on an additional hip bone sample (5mm) taken when exposed for PM.
REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
17/EM/0061
Date of REC Opinion
21 Feb 2017
REC opinion
Further Information Favourable Opinion