Fracture Risk Assessment in Adults with Ischaemic Stroke.

Abstract

Background: Stroke is an important risk factor for minimal trauma fracture (MTF) due to immobilisation, gait disturbance, vitamin D deficiency and increased falls risk. Aim(s): To study the prevalence of osteoporosis, falls and fractures in adults with ischaemic stroke. Method(s): Adults aged >=50 years admitted with ischaemic stroke at Monash Health over a 12-month period, were invited to participate in a telephone interview one year post-stroke to ascertain falls and fracture. A Fracture Risk After Ischaemic Stroke1(FRAC-stroke) score was calculated. Result(s): Of 301 adults with ischaemic stroke, 131 consented to a telephone interview. Mean age was 72.4 +/- 10.7 years and 36.6% were female. The modified Rankin Scale (mRS) on discharge was between 0-1 in 45.0%, 2-3 in 47.4% and 4-5 in 7.6%. 33 patients (25.2%) had a FRAC-stroke score of >=15, equating to >=5% risk of fracture in the year following stroke. Fourteen (10.7%) had a MTF prior to the stroke (12 female) and 17 (13.0%) had a history of osteoporosis. There was a significant difference in patients experiencing falls pre-and post-stroke (19.8 vs 31.3%, p=0.041). 62.5% of patients who had a fall pre-stroke experienced a fall post-stroke. Eleven (8.4%) patients had a MTF in the 12 months post-stroke; six fractures occurred in the upper limb and five in the lower limb/pelvis. 21.2% of patients with a FRAC-stroke of >=15 experienced a MTF in the 12 months following stroke. Receiver operating characteristic (ROC) analysis found an area under the curve (AUC) of 0.815 for FRAC-stroke score in predicting fracture with a sensitivity of 66.7% and specificity of 78.2%. Conclusion(s): Osteoporosis in patients presenting with an ischaemic stroke is not uncommon. 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 most benefit from osteoporosis therapy.