New score predicts low-trauma fractures after ischemic stroke

  • Smith EE & al.
  • JAMA Neurol
  • 13.05.2019

  • von Susan London
  • Clinical Essentials
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Takeaway

  • 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

Key results

  • 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.

Study design

  • 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.

Limitations

  • Lack of information such as bone mineral density.
  • Reliance on administrative data.