title: Risk of fractures after stroke: Results from the Ontario Stroke Registry.
abstract: OBJECTIVE
  To determine the risk of fractures after stroke.
  
  
  METHODS
  Using the Ontario Stroke Registry, we identified a population-based sample of consecutive patients seen in the emergency department or hospitalized with stroke (n = 23,751) or TIA (n = 11,240) at any of 11 stroke centers in Ontario, Canada, and discharged alive between July 1, 2003, and March 31, 2012. We compared the risk of low-trauma fractures in patients with stroke vs those with TIA using propensity score methods to adjust for differences in baseline factors. Secondary analyses compared fracture risk poststroke with that in age-/sex-matched controls without stroke or TIA (n = 23,751) identified from the Ontario Registered Persons Database.
  
  
  RESULTS
  The 2-year rate of fracture was 5.7% in those with stroke compared to 4.8% in those with TIA (adjusted cause-specific hazard ratio [aHR] for those with stroke vs TIA 1.32; 95% confidence interval [CI] 1.19-1.46) and 4.1% in age-/sex-matched controls (aHR for those with stroke vs controls 1.47; 95% CI 1.35-1.60). In the cohort with stroke, factors associated with fractures were older age, female sex, moderate stroke severity, prior fractures or falls, and preexisting osteoporosis, rheumatoid arthritis, hyperparathyroidism, and atrial fibrillation.
  
  
  CONCLUSIONS
  Stroke is associated with an increased risk of low-trauma fractures. Individuals with stroke and additional risk factors for fractures may benefit from targeted screening for low bone mineral density and initiation of treatment for fracture prevention.
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada. moira.kapral@uhn.ca.
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Leanne K
authors.initials: LK
authors.lastname: Casaubon
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Marla
authors.initials: M
authors.lastname: Prager
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Stamplecoski
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Brennan
authors.initials: B
authors.lastname: Rashkovan
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018672:Community Health Planning; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000453:epidemiology*