Using the Ontario Stroke Registry from July 1, 2003 to March 31, 2013, we identified patients 65 years or older who were seen in the emergency department or hospitalized with stroke (N = 16, 581) at 11 regional stroke centres in Ontario, Canada and discharged alive. We calculated the cumulative incidence of (1) screening with bone mineral density (BMD) testing and (2) treatment with medications for fracture prevention (including bisphosphonates, raloxifene, denosumab, calcitonin, teriparatide and estrogens), within one year following the index stroke, accounting for the competing risk of death.

Overall, within one year of the index stoke, 5.1% of patients underwent screening for osteoporosis and 15.5% were prescribed medications for fracture prevention. Results were similar when the sample was restricted to those with prior low-trauma fractures, in whom screening and/or treatment would be universally recommended in current guidelines. 

Patients with recent stroke are under-screened and under-treated for osteoporosis, which may put them at risk for future fractures. Further work should focus on 1) identifying and treating patients who are at an increased risk for fractures following stroke, 2) educating clinicians on this topic, and 3) developing clinical practice guidelines that are aimed at reducing the incidence of post-stroke fractures.