Low Rates of Osteoporosis Screening in Patients With Recent Stroke Despite High Fracture Risk

Rates of osteoporosis screening and treatment are low in patients with recent stroke despite the known increased risk for low-trauma fracture in this population, according to study results published in Stroke.

Clinical practice guidelines for osteoporosis do not include stroke in their risk stratification systems and guidelines for stroke do not provide recommendations for osteoporosis testing or treatment, other than fall prevention.

To better understand current patterns of poststroke osteoporosis management, researchers identified patients aged ≥65 years from the Ontario Stroke Registry in Canada who were diagnosed with nonfatal ischemic stroke or intracerebral hemorrhage between July 2003 and March 2013. Registry data were linked to information in population-based administrative databases to identify patients’ outcomes for bone mineral density (BMD) testing with dual-energy X-ray absorptiometry, medication prescriptions, and mortality. Hazard models were used to estimate how several covariates affected rates of BMD testing and osteoporosis pharmacotherapy.

Of 16,581 patients included in the study sample, only 5.1% underwent testing for BMD, of whom 15.5% received a prescription for osteoporosis medication within 1 year of index stroke. BMD testing was performed in 2.9% of patients without prior screening.

In patients who had never received osteoporosis pharmacotherapy (bisphosphonates, raloxifene, denosumab, calcitonin, or estrogens), medication was prescribed in 3.2% of the overall cohort, 7.8% of patients with fractures prior to stroke, and 14.8% of patients who had fractures occurring after stroke.

Certain covariates including female sex, prior diagnosis of osteoporosis or fracture, prior BMD testing, and poststroke fractures and falls were associated with prescription of osteoporosis medication after stroke in patients who had not used pharmacotherapy within the previous year.

The researchers noted some limitations to this study, including lack of data on why individual patients did not undergo screening or receive treatment, as well as likely underreporting of falls and preexisting osteoporosis in the administrative databases.

“We found that only a minority of people were screened or treated for osteoporosis after stroke… even in high-risk subgroups,” wrote the investigators.

“Screening and treatment may be particularly low poststroke because of under-recognition of osteoporosis as a consequence of stroke, a selective focus on the management of cardiovascular risk and stroke recovery, or factors such as dysphagia precluding use of oral bisphosphonates.”

One author declared associations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

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