EP269 - ECE_1912 - Post-stroke fracture risk: intracerebral haemorrhage vs ischaemic stroke—a systematic review and meta-analysis

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Abstract Background Stroke can be divided into two subtypes—intracerebral haemorrhage (ICH) and ischaemic stroke (IS), of which ICH constitutes 28.8% of strokes and contributes to significant mortality and morbidity. Heightened fracture risk in stroke survivors is a well-established physical complication. The mechanisms for this are multifactorial, culminating in skeletal fragility and falls. Despite this, there is inconsistent evidence surrounding post-stroke fracture rates depending on stroke aetiology. Objective Examine the current literature in post-stroke fracture outcomes in both stroke subtypes. Methods A systematic review was conducted in accordance to PRISMA guidelines, with PROSPERO registration. We searched Ovid MEDLINE, Scopus, Cochrane Database and Embase up to November 2025 for observational studies reporting post-stroke fracture outcomes in adults with confirmed ICH, with comparisons to IS. Additionally, backward citation screening was carried out. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A meta-analysis is currently underway. Results Fifteen total studies were identified through screening methods. Five analysed cumulative incident fractures, three provided sub-analysis of fracture rates at multiple fracture locations, four focused solely on hip fractures, and one focused particularly on “‘low-trauma” fractures. The remaining two studies utilised stroke subtype as a co-variate only and thus did not present meaningful data. Results across the included studies were inconsistent in establishing whether IS or ICH is associated with a greater fracture risk, with only four reporting a statistically significant difference. These included three reporting increase fracture rate in the ICH cohort. Two of these studies, Zheng et al. and Lee et al., compared each stroke subtype against a matched non-stroke control group rather than conducting a direct comparison between ICH and IS. Whereas the study Lisabeth et al. reported increased overall fracture rates in the ICH with a hazard ratio of 1.93 (95% CI: 1.11-3.34) when directly compared to IS. Interestingly, one study reported higher fracture rates in the alternative stroke subtype. Conclusions There is some evidence suggests that ICH may be associated with higher fracture risk than IS, however a formal meta-analysis is currently pending. Based on the included studies, it is clear that both stroke subtypes are associated with increased fracture risk and in turn poor bone health outcomes. The limited number of studies comparing stroke subtypes highlights the need for more robust and well-designed studies. Overall, these results support the need for implementation of a generic approach to post-stroke bone health assessment and fracture prevention.

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