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Publications

Journal Article Validation Study Ppublish

PubMed: 41964513 DOI: 10.1093/jbmr/zjag065

Validating the FRAC-Stroke score: targeting those at highest risk of fracture.

J Bone Miner Res 41(11):1186-1194

Authors: Gabrielle Stokes, Anne Trinh, Nadine E Andrew, Dominique A Cadilhac, Peter R Ebeling, Karen Borschmann, Monique F Kilkenny, Joosup Kim, Lachlan L Dalli, Frances Milat

Affiliations

  • Centre for Endocrinology and Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia. Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia.
  • Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia.
  • The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC 3084, Australia. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia.
  • Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia. Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia.
  • The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC 3084, Australia.
  • Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia.

Abstract

Fracture risk is increased after stroke, but there is a lack of specific, effective tools to screen and prevent minimal trauma fractures (MTF) post-stroke. While the Fracture Risk after Ischemic Stroke score (FRAC-Stroke score), developed to predict fracture risk post-stroke, shows promising performance, it has not yet been widely adopted or validated in large cohorts outside of Canada. We aimed to: (1) evaluate the reliability and validity of the FRAC-Stroke score in predicting MTF and (2) determine the optimal score to classify patients at highest fracture risk following ischemic stroke. A retrospective cohort study was undertaken using data from the PRECISE study, which included person-level linked administrative data from the Australian Stroke Clinical Registry (AuSCR, 2014-2016). The FRAC-Stroke score at hospital discharge was determined for survivors of ischemic stroke, aged >50 yr, using coded comorbidities derived in the prior 5-yr period and modified Rankin Scale. Fine-Gray models were built to evaluate associations of the FRAC-Stroke score with MTF within 12 mo post-discharge, accounting for death as the competing risk. Among 4545 adults, the median FRAC-Stroke score was 8 (IQR 5-11) and 118 patients (2.6%) sustained a MTF within 12 mo post-discharge. The optimal FRAC-Stroke score cut-point to stratify MTF risk was 11.5, with a c-statistic of 0.70. Participants with a FRAC-Stroke score ≥12 (vs <12) had a 5.5-fold increased risk of MTF (CI 3.8-7.9, p < .01). When stratified by quintiles of FRAC-Stroke score, those in quintile 5 (FRAC-Stroke score ≥ 14) had a 15.2-fold increased risk of MTF than those in quintile 1 (FRAC-Stroke score < 3; CI 6.6-35.2, p < .01). The FRAC-Stroke score reliably identifies increased fracture risk in the Australian ischemic stroke population, with a score of 12+ able to discriminate those at high risk of fracture.

MeSH

Confidence Intervals, Ischemic Stroke, Stroke, Osteoporosis