A 4-year-old girl is brought to the physician for increasingly severe pain of her right leg after falling from a slide on the playground. She recently immigrated to the USA with her family from Ireland. Her parents are vegan. Physical examination shows swelling, tenderness, and limited range of motion of the right lower extremity. Vitals are within normal limits. X-ray shows a tibial fracture. Which of the following is the most likely explanation for these findings?
Child abuse
Decreased collagen synthesis
Decreased osteoclast activity
Impaired intestinal ion absorption
Increased parathyroid hormone secretion
