Stroke survivors have a 7-fold increased risk of fragility fractures, which prolongs post-stroke disability and increases mortality. Mechanisms leading to increased fracture include immobility, gait disturbance, vitamin D deficiency and falls risk. The Fracture Risk After Ischaemic Stroke (FRAC-Stroke) score is a clinical tool that has been validated to assess risk of fracture in the 12 months following ischaemic stroke.
We studied the prevalence of osteoporosis, falls and fractures in adults aged ≥ 50 years admitted with ischaemic stroke over 12-months to Monash Health. Patients were invited to participate in a telephone interview one-year following stroke to ascertain falls and fracture. A FRAC-stroke score was calculated.
Of the 316 adults with ischaemic stroke, 131 had a telephone interview: mean age was 72.4 ± 10.7 years and 36.6% were female. 34 patients (25.9%) had a FRAC-stroke score of ≥ 15, equating to ≥ 5% risk of fracture in the year following stroke. Eleven (8.4%) patients (6 female) had a fragility fracture in the 12 months post-stroke. FRAC-stroke score was higher in those who had a fracture post stroke compared with those who did not (20.4 vs 8.9, p < 0.001). Receiver operating characteristic analysis found an area under the curve of 0.867 for FRAC-stroke score (95% CI 0.785-0.949, p < 0.005). The optimal cut-off value for FRAC-stroke score predicting fracture was 12 with a sensitivity of 90.9% and specificity of 70% (1).
This study found that a simple bedside tool, the FRAC-stroke score, can predict fracture after ischaemic stroke. This allows clinicians to plan treatment of osteoporosis following stroke. Further research to determine optimal management is urgently needed.