Introduction: Following stroke, bone mineral density (BMD) has been found to decline, particularly in the paretic extremity. Decreased BMD in combination with an increased risk of falls predisposes individuals to post-stroke fractures, which can result in serious disability. Despite this, current post-stroke best practice guidelines do not include recommendations on screening and treatment for osteoporosis or bone loss. The purpose of this study was to determine the frequency of BMD testing and prescribing of medications for treatment and prevention of osteoporosis following stroke.
Hypothesis: We hypothesized that rates of screening and treatment for osteoporosis would be low following stroke.
Methods: We performed a retrospective cohort study of patients aged over 20 years who were seen in the emergency department or hospitalized with stroke at any Ontario acute care institution between 2003 and 2012 and discharged alive. We identified BMD testing through the physician claims database and medication prescriptions in patients aged over 65 years using the Ontario Drug Benefits database.
Results: Among 23,751 patients with stroke, only 4.8% of patients underwent BMD testing within 1 year and 15.5% of those aged over 65 were prescribed therapy for osteoporosis. In the 1,912 patients who sustained a low-trauma fracture within 2 years after stroke, BMD testing was conducted in only 9% and osteoporosis therapy was prescribed to 31.3% of those over 65 years.
Conclusions: Following stroke, rates of testing and treatment for osteoporosis are very low, even in those with fractures. Due to the bone loss that may occur following stroke, it is recommended that high-risk individuals be targeted for BMD screening after stroke and treated accordingly.