Screening and Treatment for Osteoporosis After Stroke

Background and Purpose— Stroke is a risk factor for subsequent osteoporosis and fractures. We sought to understand current rates and predictors of screening and treatment for bone loss after stroke. Methods— Using the Ontario Stroke Registry from July 1, 2003 to March 31, 2013, we identified patients ≥65 years who were seen in the emergency department or hospitalized with stroke at 11 regional stroke centers in Ontario, Canada and discharged alive. We calculated the cumulative incidence of (1) screening with bone mineral density testing and (2) treatment with medications for fracture prevention, within 1 year after the index stroke, accounting for the competing risk of death. We then used cause-specific hazard models to estimate the effect of various covariates on the cause-specific hazard of bone mineral density testing and osteoporosis pharmacotherapy. Results— In the sample of 16 581 patients, 5.1% overall and 2.9% of those without prior testing underwent screening bone mineral density testing, and 15.5% overall and 3.2% of those not previously on treatment were prescribed medications for fracture prevention within 1 year after stroke. Results were similar in all subgroups of patients. Female sex, prestroke osteoporosis, and poststroke falls and fractures were associated with increased rates of osteoporosis pharmacotherapy. Conclusions— Patients with recent stroke are infrequently screened and treated for osteoporosis, which may increase the risk of fractures. Future work should focus on identifying and treating patients who are at increased risk of fractures after stroke.