EP303 - ECE_1917 - Management of osteoporosis in stroke patients: a systematic review of clinical practice guidelines

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Abstract Background Stroke is a leading cause of mortality and morbidity worldwide, with stroke survivors suffering a wide range of post-stroke complications. Osteoporosis is a well-established complication post-stroke due to accelerated bone and muscle loss. While this is a significant driver of fractures, osteoporosis post-stroke remains substantially underdiagnosed and undertreated. Objective To evaluate current clinical guidelines and recommendations for osteoporosis screening, prevention and treatment post-stroke. Methods A systematic review was conducted and reported in accordance to PRISMA guidelines, with PROSPERO registration. We searched OVID MEDLINE, Embase, Emcare and Web of Science databases up to 05/01/2026 with a complementary search for websites of major international societies, national professional bodies specialising in the care of stroke and/or osteoporosis and Guidelines International Network (GIN). Identified guidelines were appraised using the AGREE-II (Appraisal of Guidelines for Research and Evaluation) tool. Results Nine clinical guidelines across five countries were identified, including guidelines from the United Kingdom (n = 3), the United States (n = 3), Singapore (n = 1), Malaysia (n = 1) and South Africa (n = 1). Five were osteoporosis guidelines that included information on post-stroke osteoporosis, while the remaining 4 guidelines were stroke guidelines that identified osteoporosis as a post-stroke complication. All osteoporosis guidelines nested stroke as a risk factor for osteoporosis and fractures among other neurological conditions, with no additional stroke-specific information on fracture prevention and treatment of osteoporosis. Among the four stroke guidelines, fracture risk assessment was recommended as part of stroke rehabilitation but no specific details about stroke-specific fracture risk assessment. Three of four stroke guidelines recommended improving levels of physical activity and vitamin D and calcium supplementation to avert post-stroke osteoporosis. Appraisal of identified guidelines using the AGREE-II is currently underway. Conclusions Despite the documented high fracture rates post-stroke, health professionals do not have adequate guidance to support the management of osteoporosis in this setting. Although acknowledged as a secondary cause of osteoporosis, stroke-specific guidance remains largely lacking from osteoporosis clinical practice guidelines. While the included stroke clinical practice guidelines included offered more targeted guidance on the screening and prevention of osteoporosis, these represent a small fraction of stroke guidelines worldwide. Providing specific recommendations post-stroke related to bone health in national osteoporosis guidelines should be a priority given the high burden of fracture in the patient population.

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