- The Fracture Risk after Ischemic Stroke (FRAC-Stroke) score may help clinicians identify patients at elevated risk for low-trauma fracture in the year after ischemic stroke.
Why this matters
- Stroke survivors have more than 30% higher risk for such fractures overall, but with variability across individuals.
- World Health Organization’s FRAX score is not tailored for stroke survivors.
- 7 multivariate predictors in FRAC-Stroke score: age, sex, discharge modified Rankin score, history of rheumatoid arthritis, osteoporosis, previous falls, previous fracture.
- Model C statistic:
- 0.72 in derivation cohort.
- 0.70 in validation cohort.
- Range of cumulative incidence of 1-year low-trauma fracture going from lowest to highest FRAC-Stroke quintile:
- Derivation cohort: from 1.1% to 9.0%.
- Validation cohort: from 1.3% to 9.0%.
- In validation cohort, good correspondence of score-predicted and observed fracture rates.
- FRAC-Stroke score available online.
- Canadian population-based study:
- Derivation cohort of 20,435 adults hospitalized with ischemic stroke over 9 years and having 1 year of follow-up.
- External validation cohort of 13,698 consecutive stroke admissions over 5 years.
- Main outcome: incident low-trauma fracture within 1 year of discharge.
- Funding: Heart and Stroke Foundation of Canada; others.
- Lack of information such as bone mineral density.
- Reliance on administrative data.