Fracture risk and bone health following a stroke are inadequately considered by physicians: A UK survey of practice

BackgroundOsteoporotic fragility fractures and stroke disease are both common. Fracture risk is substantially increased following a stroke. Fracture risk assessment tools are available (e.g. FRAX/Qfracture); however, stroke guidelines provide little advice. We aimed to determine current practice amongst UK stroke physicians regarding assessment and management of bone health in patients following a stroke.MethodsAn anonymous web-based survey was emailed to all 140 NHS consultant stroke physicians registered with the British Association of Stroke Physicians (BASP) from November 2013 to April 2014. Multiple choice questions determined current usual practice.ResultsAlmost all (98.5%) reported working in NHS trusts with no specific post-stroke bone health guidance. Fewer than 1/6 were fully aware of post-stroke fracture risk; most underestimated risk. Less than 1/10 regularly assessed bone health post-stroke, in contrast 78.1% regularly assessed falls risk. Despite this, 89.5% who assessed falls risk did not continue to consider fracture risk. None routinely used FRAX or Qfracture; many were unaware of these tools. Only 3% regularly initiated anti-resorptive medication to reduce post-stroke fracture risk, 45.2% never considered the impact of phenytoin on bone health if prescribed for post-stroke epilepsy.ConclusionsWe found marked heterogeneity in the approach of UK stroke physicians to the assessment of fracture risk and management of bone health in stroke patients with overall under-appreciation of fracture risk and low levels of assessment. Our findings support the need for clear guidelines regarding fracture risk assessment and bone health in patients who have experienced a stroke.