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New scoring tool can predict risk of fracture after stroke


A new risk score, called the Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score, developed by researchers at ICES and the University of Calgary can predict the probability of fracture within one year after a stroke. 

The research findings are published in the most recent issue of JAMA Neurology.

Stroke is associated with an increased risk of bone loss and fractures. However, people with recent stroke are infrequently tested or treated for osteoporosis.
“We wanted to develop a risk score that could identify which people with stroke are at particularly high risk for fractures to allow for targeted testing and treatment in these people,” says Dr. Moira Kapral, author of the study and a senior scientist at ICES.

The researchers used data from the Ontario Stroke Registry to develop the FRAC-Stroke Score to predict the probability of fracture within one year after a stroke. Variables included in the score were age, female sex, post-stroke disability, rheumatoid arthritis, prior diagnosis of osteoporosis, and previous falls and fractures.

The study looked at data for 20,435 Ontario patients with ischemic stroke discharged from 2003 to 2012, and found 741 (3.6 per cent) patients had a non-traumatic fracture within one year after stroke. The researchers found that the risk of fracture after stroke varied from approximately one per cent to nine per cent depending on the patient risk score.

“This score can be used by clinicians to identify patients at higher risk of fracture so that they can receive interventions to prevent fractures,” says Dr. Eric Smith, lead author of the study and associate professor of neurology, Katthy Taylor Chair in Vascular Dementia, Cumming School of Medicine, University of Calgary. 

Author block: Eric E. Smith, Jiming Fang, Shabbir M. Alibhai, Peter Cram, Angela M. Cheung, Leanne K. Casaubon, Eshita Kapoor, Peter C. Austin and Moira K. Kapral.

The report “Derivation and external validation of a scoring system for predicting fracture risk after ischemic stroke in a Canadian cohort,” is published in the May 13 issue of JAMA Neurology.

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