Abstract
Introduction:
Osteoporosis is a known consequence of stroke, associated with an increased incidence of fractures and leading to further disability. The pattern of bone loss seen in stroke patients is different from that usually seen with postmenopausal osteoporosis. It depends on the degree of paresis, gait disability, and the duration of immobilisation.
Methods:
We retrospectively analyzed data from 20 patients admitted to the stroke ward. All patients with stroke aged more than 65 years were included in the data. Patients who were less than 65 years old, non-stroke patients, and patients who passed away during admission were excluded. Results: Fall risk assessment showed 25% of patients were low risk, 35% were medium risk, and 40% were high risk. Among them, 15% of the patients had a history of osteoporosis. Only 25% of patients had osteoporosis treatment before admission. 15% had a history of vertebral/femoral fracture in the past. We calculated the FRAX score for all patients (low risk in 44%, intermediate risk in 44%, and high risk in 12%). We compared the pre- and post-admission osteoporosis treatment (25% vs. 30%).
Proposed Plan:
Check vitamin D levels for all patients admitted to the stroke ward. Conduct falls risk assessments for all patients. Calculate FRAX scores for all patients under 90 years. Provide osteoporosis treatment if a previous vertebral fracture is found incidentally, unless contraindicated. If creatinine clearance is less than 30%, refer to the fracture liaison service or ask the GP to refer.
Conclusion:
This study highlights the high prevalence of osteoporosis and fall risk among stroke patients, emphasizing the need for routine osteoporosis screening and treatment in this population. Implementing systematic assessments and appropriate interventions can potentially reduce the risk of fractures and improve the overall quality of life for stroke patients.
Comments
Question
Hello and thank you for presenting your work. When patients were having their vitamin D levels checked, was there a significant difference in levels between patients of different pre-stroke mobility groups? It looks like your plan for all stroke patients is to receive vitamin D without checking serum vitamin D levels, is that correct? How did you go about communicating the proposed plan to primary care before the implementation whereby you ask GPs to request DEXA scans for stroke patients at risk of osteoporosis?
Dear Dr McRae,
Thank you for your response.
Are you referring to the Elderly Mobility Scale? No, we did not analyse the difference in Vit D levels between mobility groups but this is a pertinent observation.
We do recommend checking Vitamin D levels in all patients. This may have not been clear from the poster, but after vitamin D is requested, we adhere to trust guidelines regarding a replacement regimen depending on the levels.
We have not communicated any plan to primary care at this stage. The flow chart displayed is a proposed plan and has not been implemented.
We are appreciative of the time constraints of GPs and we do not propose that GPs refer all stroke patients at possible risk of osteoporosis for a DEXA.
The suggestion is that the hospital would identify the minority of stroke pateints that fall into this category (as per the flow chart) and refer onwards.
Please let me know if you have further querie.