Majority of People Who Have Stroke Not Screened for Osteoporosis Despite Increased Risk

People who have a stroke often experience reduced mobility as a result, which is associated with decreased bone mineral density. But despite stroke being a risk factor for osteoporosis, broken bones, and falls, the majority of stroke survivors are not screened nor treated for these conditions, according to new research.

Data on 16,581 patients aged 65 or older who visited the emergency department or were hospitalized for stroke at 11 stroke centers in Ontario, Canada between July 1, 2003, and March, 31, 2013, revealed that just 5.1% of patients underwent bone mineral density testing and 15.1% were prescribed treatment for osteoporosis within 1 year following their stroke.

“Osteoporosis as a complication of stroke is described in US stroke guidelines but is not accompanied by recommendations for testing and treatment, other than falls prevention strategies,” wrote the researchers, who noted that osteoporosis clinical practice guidelines do not explicitly address stroke in their risk stratification systems. However, they do recommend screening for women aged 65 and older and in certain men and younger adults, as well as individualized fracture risk assessment and treatment.

Among patients with no previous bone mineral density testing, 2.9% received testing, and among those not previously treated for osteoporosis, 3.2% of the overall cohort received treatment while 7.8% of those with prestrike fractures and 14.8% of those with post-stroke fractures received treatment.

“Our study adds to previous research that found despite an increased risk, only a small number of people who have recently had a stroke are tested and treated for osteoporosis,” said Moira Kapral, MD, MSc, FRCPC, professor of medicine and director of the division of internal medicine at the University of Toronto, and lead author of the study, in a statement. Previous research has estimated that approximately 27% of older women are screened for osteoporosis and approximately 30% considered high risk are treated.

The researchers noted that stroke severity and comorbid conditions were not associated with post-stroke osteoporosis screening or treatment.

For patients who had not had screening in the previous 5 years, those who were younger, female, and had low-trauma fractures in the year post-stroke were more likely to have post-stroke bone mineral density testing. Similarly, among patients who had not used osteoporosis medication in the previous year, those who were female, had prior osteoporosis, prior fractures, prior bone mineral density testing, and post-stroke fractures and falls were more likely to be prescribed medication post-stroke.

Reference:

Kapoor E, Austin P, Alibhai S, et al. Screening and treatment for osteoporosis after stroke [published online April 25, 2019]. Stroke. doi: 10.1161/STROKEAHA.118.024685.