Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

INTRODUCTION@#The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically. Therefore, we aimed to evaluate the risk factors associated with fragility fractures in children with LTNC.@*METHODS@#In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC on follow-up in the paediatric neurology clinic and patients who presented with fracture to the paediatric orthopaedic clinic. Information on patients' demographics, medical history, intervention, biochemical bone markers and fracture history was collected.@*RESULTS@#In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (Gross Motor Function Classification System [GMFCS] V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or were on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% and 33% of the patients had undergone measurements of vitamin D and calcium levels, respectively.@*CONCLUSION@#The local prevalence of fragility fractures in children with LTNC on follow-up at the neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimise bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight children, avoiding vitamin D deficiency and ensuring adequate calcium intake.

Understanding and Navigating Mental Health Resources in the Community through a Case Study

@#This article shows how Primary Care Physicians can manage stable chronic schizophrenia with complex psycho-social issues in the community. This is made possible through improved access to mental healthcare services. The case study highlights the utilisation of the Mental Health-GP Partnership Programme and Community Mental Health Team to facilitate a smooth transition and maintenance of mental well-being in the community. Resources like Aged Psychiatry Community Assessment and Treatment Service, Assessment and Shared Care Teams, Community Intervention Teams are discussed as well as future directions to strengthen care in the community.

Genetic Syndromes and Associated Cariovascular Anomalies in Adults: A Singapore Perspective

@#Children with genetic syndromes are increasingly surviving to adulthood in Singapore. This is due to early detection and significantly improved multi-dimensional care. Congenital heart disease is one of the characteristic abnormalities in patients. However, the cardiac anomalies of some of these patients may only manifest later in early adulthood. A significant number of such patients are not on regular medical follow-ups to monitor for future complications. This article describes based on the common syndromic conditions that are present in Singapore. Advanced genetic tests like chromosomal microarray analysis can help diagnose these syndromes that are not obvious clinically, thus instituting appropriate management and treatment for such patients. Creating awareness of such syndromes and its cardiac complications will translate to them being referred to the cardiologists to prevent further morbidity and mortality. Timely counselling regarding fertility, prenatal testing and complications due to pregnancy are also discussed in this article.

Working in Multidisciplinary teams for the Family Physician

This article shows how a typical patient with multiple chronic medical problems can be managed well by a Family Physician despite the pressure of time in Singapore. Resources like the Agency for Integrated Care, Community Health Centres, Centre-based Services, and Social Service Offices will be discussed in the context of how they help the busy Family Physician to stabilise multiple chronic medical problems in the community based on a multidisciplinary team care model. Optimal utilisation of such resources by family physicians can significantly alleviate the chronic patient load in the hospitals and government polyclinics. Furthermore, this will promote the Ministry of Health’s vision of “One Singaporean, One Family Doctor.”