Background
Stroke is an important risk factor for minimal trauma fracture (MTF) due to immobilisation, gait disturbance and increased falls risk, yet it is neglected in guidelines worldwide.
Aim
To study the prevalence of osteoporosis, falls and fractures in adults with ischaemic stroke.
Methods
Retrospective cohort study of adults aged ≥50 years admitted with ischaemic stroke at Monash Health over a 6-month period in 2020. A subset of 50 patients had telephone interviews to ascertain falls and fracture 12 months post-stroke and to calculate a Fracture Risk After Ischaemic Stroke (FRAC-stroke) score.
Results
141 adults were admitted with stroke over a 6-month period; mean age was 74.7 ± 11.3 years and 39% were female. The modified Rankin Scale (mRS) on discharge was between 0-1 in 42.5%, 2-3 in 41.1% and 4-5 in 16.3%. Vitamin D levels were assessed in 26.2%, with a median vitamin D level of 55 nmol/L (IQR 40-76 nmol/L).
Of the 50 patients contacted for interviews: 26% (n=13) and 10% (n=5) had a FRAC-stroke score of ≥16 and ≥23 respectively, equating to a 5% and 10% risk of fracture in the year following stroke. Nine (18%) had a MTF prior to the stroke and eight (16%) had a history of known osteoporosis. 19 patients (38%) had a fall in the 12 months post-stroke with 9 (18%) having multiple falls. Only 7 patients (14%) had a history of falls prior to stroke. Two patients had a MTF in the 12 months post-stroke with a FRAC-stroke score of 22 and 26 (multisite fracture of hip/leg/radius and radius respectively).
Conclusion
The FRAC-stroke score is a simple clinical tool that can be used to identify patients at high risk of fracture post-stroke who would benefit most from osteoporosis therapy.