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 aim to evaluate the risk factors associated with fragilty fractures in children with LTNC. Methods: In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC who are under follow-up in the Paediatric Neurology clinic and of patients who presented with fracture to the Paediatric Orthopaedic clinic. Information on patient’s demographics, medical history, intervention, biochemical bone markers and fracture history were collected. Results: In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (GMFCS V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or 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% had a vitamin D level measured and 33% had calcium measured. Conclusion: The local prevalence of fragility fractures in children with LTNC who are under 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 optimize bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight, avoiding vitamin D deficiency and ensuring adequate calcium intake.