Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Fracture Risk Assessment in Adults with Ischaemic Stroke (#225)

Basil S Liu 1 , Chrislyn Ng 2 , Anne Trinh 1 2 3 , Phillip Wong 1 2 3 , Peter R Ebeling 1 2 , Shaloo Singhal 1 2 , Thanh Phan 1 2 , Frances Milat 1 2 3
  1. Monash Health, Clayton, Victoria, Australia
  2. Monash University, Clayton, Victoria, Australia
  3. Hudson Institute of Medical Research, Melbourne, Victoria, Australia

Background: Stroke is an important risk factor for minimal trauma fracture (MTF) due to immobilisation, gait disturbance, vitamin D deficiency and increased falls risk.

Aims: To study the prevalence of osteoporosis, falls and fractures in adults with ischaemic stroke.

Methods:  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. 

Results: 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: 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.

  1. Smith EE et al. JAMA Neurol. 2019 Aug 1;76(8):925-931. Derivation and External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke in a Canadian Cohort.