Reply to Letter to the Editor: Unexplained Fractures: Child Abuse or Bone Disease: A Systematic Review

Excerpt

We thank Drs. Karst and van Rijn for bringing to our notice as well as that of the readership, issues regarding the study by Paterson et al. [2]. The fact that the existence of ‘temporary brittle bone disease’ as a variant of osteogenesis imperfecta has been challenged and in some ways shown to be nonscientific was known and of interest to us. We were, however, unaware (as an entire group of coauthors of our study [1]) of the court ruling from the United Kingdom related to the study Paterson et al. [2], and we welcome the clarification provided by Drs. Karst and van Rijn regarding the unscientific basis of ‘temporary brittle bone disease.’ Their point is even more relevant in light of the fact that the MOOSE group (Meta-analysis of Observational Studies in Epidemiology) state in their guidelines that because observational studies are vulnerable to bias confounding and chance, readers should consider explanations for the observations other than the conclusions of the authors [3]. However, had we known a priori about this issue, the study by Paterson et al. [2] still would have met our search criteria and our inclusion and exclusion criteria. As such, strict observation of systematic review technique would dictate that it be included. However, we would have made note of the controversy. …