Fracture Risk Increases After Stroke or Transient Ischemic Attack and Is Associated With Reduced Quality of Life.

Background: Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA.
Methods: Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009-2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture.
Results: Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%-80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05-1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21-1.50]), history of prior fracture(s; IRR, 2.56 [95% CI, 1.77-3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10-1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49-0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort.
Conclusions: Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.
Competing Interests: Disclosures Dr Cadilhac reports being the current Data Custodian for Australian Stroke Clinical Registry (AuSCR) and reports educational grants from Amgen Australia, Boehringer Ingelheim, Medtronic, and Bristol Myers Squibb outside the submitted work. Drs Cadilhac, Lannin, Grimley, and Kilkenny are members of the AuSCR Steering or Management Committees. Dr Andrew is a member of the AuSCR Research Task Group. Drs Andrew and Kilkenny are members of Stroke Foundation Research Advisory Committee. Dr Kilkenny reports educational grants from Amgen Australia and GSK outside the submitted work. Dr Dalli reports an educational grant from GSK outside the submitted work. Dr Lannin reports grants from the National Health and Medical Research Council, Heart Foundation, and Medical Research Future Fund. Dr Grimley reports receiving grants from Queensland Health and membership of the Stroke Foundation Advisory Committee. Dr Borschmann reports a Medical Research Future Fund grant from the Australian Government outside the submitted work.