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Challenges in comparing physical abuse, fractures and metabolic bone disease in young children in the UK and Sweden
  1. Piers D Mitchell1,
  2. Richard Brown2,
  3. Tengyao Wang3,
  4. Rajen D Shah3,
  5. Richard J Samworth3
  1. 1 Orthopaedics, Peterborough City Hospital, Peterborough, UK
  2. 2 Paediatrics, Addenbrookes Hospital, Cambridge, UK
  3. 3 Statistical Laboratory, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Piers D Mitchell, Orthopaedics, Peterborough City Hospital, Peterborough PE3 9GZ, UK; piers.mitchell{at}

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We were very interested to hear of the views of Högberg et al regarding our paper recently published in ADC.1 We note that they are not criticising our study, but compare data from our paper with theirs on metabolic bone disease (MBD) in infants that was published in PLOS ONE in 2018.2 They argue that if there is a sevenfold difference in the identification of physical abuse as the cause of fractures in infants between the East Anglia region of the UK and Sweden, then perhaps MBD is being mistaken for physical abuse in the UK. If found to be true, this is clearly very important. There are two main areas we should discuss:

  1. Can we safely compare the figure of 2.3% of infants in Sweden with a fracture being due to physical abuse, with the 18.9% figure we noted for the UK? Please note our incidence of abuse in infants with a fracture was 18.9%, not 21.2% as …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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