Notes for presentation:

Notes for presentation:
Temporary Brittle Bone disease and Abusive Head Trauma: Lack of evidence for a fundamentally
flawed belief system.
Dr Jan Connors
In 1990 Dr Colin Patterson published a paper (Paterson, 1990) suggesting that there was a condition
where the bones of young children were found to be weak for a short period of time and he coined
the term Temporary Brittle Bone Disease (TBBD). This was followed by his paper in 1993 (Paterson,
1993) in which he proposed that the condition of TBBD may be due to copper deficiency. Since that
time there has been ongoing debate in the literature, as recent as 2013, as to whether such a
condition does indeed exist, and if so, what the underlying cause is. On reviewing the evidence for
and against the condition, it can be said that there is no evidence to support the existence of TBBD;
that the rationale used by the proponents of this condition is fundamentally flawed.
Over the years the proponents of TBBD have shown a lack of knowledge of the evidence base known
to clinicians working in the area of forensic medical assessment of injury including mechanism of
injury. Over 23 years, published articles have included significantly flawed methodology and make
statements that are not backed by fact. In that 23 years the published literature has added little,
reviewing the same or similar cohort and repeating already published findings and conclusions. The
articles state beliefs rather than what is based in science. Journals continue to publish these articles
without appropriate peer review, and continue to portray belief as fact.
The presentation will outline how the debate has unfolded over the past 23 years, the various
explanations that have been proposed for TBBD and review the validity of such proposals.
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