Incidence, characteristics and consequences of fractures after acute ischemic stroke and TIA - a prospective cohort study.

BackgroundRecent advances in acute stroke therapy improved short-term outcome, but some of this benefit may be lost due to post-stroke complications, including fractures.AimsWe assessed the incidence of fractures before and after stroke and TIA, the risk factors for fractures, and the consequences for mortality, functional outcome and quality of life.MethodsConsecutive patients with acute ischemic stroke or TIA from the prospective STROKE-CARD Registry and the randomized controlled STROKE-CARD trial and its long-term follow-up were analyzed. We prospectively assessed all fractures using self-report and documentation, records of hospitals and general practitioners and electronic health records with all radiographs.ResultsA total of 2513 patients were included (median age 72 years [IQR 61-79]), 39.2% female). In the first year after the event, 145 individuals (5.8%, 95%CI 4.9%-6.7%) experienced 152 fractures corresponding to an incidence rate of 61.87 (95%CI 52.04-71.71) per 1000 person-years. Rates were similar after stroke and TIA (60.84 and 72.28 per 1000 person-years). The incidence of fractures was more than five times higher compared to the general population (age- and sex-adjusted HR for first fracture 5.36, 95%CI 2.49-11.52). The risk of fractures one year before stroke/TIA was also increased (HR 2.99, 95%CI 1.39-6.42). Stroke/TIA further increased the risk of fractures as documented by a comparison between fractures one year before and one year after the event (age- and sex-adjusted RR, 1.69, 95%CI 1.10-2.58). The main risk factors for fractures were falls and osteoporosis. Fracture after stroke/TIA was associated with death (aOR 2.16, 95%CI 1.20-3.89), inability to walk (aOR 2.06, 95%CI 1.08-3.93) and poor quality of life.ConclusionsPatients with ischemic stroke and TIA are at high risk for future fractures. Fracture after stroke/TIA is strongly associated with death, poor functional outcome and reduced health-related quality of life. Therefore, there is a need to incorporate fracture prevention into post-stroke care to improve patient outcomes.Trial RegistrationSTROKE-CARD Registry (NCT04582825, https://clinicaltrials.gov/study/NCT04582825)STROKE-CARD trial (NCT02156778, https://clinicaltrials.gov/study/NCT02156778)STROKE-CARD long-term follow-up (NCT04205006, https://clinicaltrials.gov/study/NCT04205006).Data access statementAnonymized patient data are available for use in independent scientific research to researchers upon reasonable request (stefan.kiechl@i-med.ac.at).