Summary:​ We assessed the long-term incidence of fractures after stroke and TIA and analyzed associated factors. The fracture incidence increases with age and is higher in stroke than in TIA. Dementia is associated with fractures after both. Our results indicate tailored measures are necessary for preventing fractures after stroke or TIA.

Introduction:​ In the present study, we aimed to assess the long-term incidence of fractures and analyze associated factors after stroke or transient ischemic attack (TIA).

Methods:​ The current cohort study included patients who had received an initial ischemic stroke or TIA diagnosis documented anonymously in the Disease Analyzer database (IQVIA) between 2000 and 2016 by physicians in 1262 general practices in Germany. Univariate Cox and multivariate regression models were carried out.

Results:​ Three groups (stroke, TIA, no stroke/TIA), each with 12,265 individuals, were selected (mean age 67.3 years, 48.1% female). A fracture was diagnosed in 12.9% of stroke patients and in 11.4% of TIA patients. Among male stroke patients, 11.1% had a fracture (15.4% among female stroke patients). The hazard ratio (HR) for fractures after stroke was 1.26 (CI:​ 1.15–1.39) and for fractures after TIA, it was 1.14 (CI:​ 1.03–1.25). In female stroke patients, the HR for fractures was 1.32 (CI:​ 1.15–1.60), while in males, it was 1.20 (CI:​ 1.03–1.39). Among TIA patients, females had an elevated HR for fractures (HR:​ 1.21;​ CI:​ 1.06–1.37). In individuals aged ≥ 80 years, an increased risk for fractures was only detected among TIA patients (HR:​ 1.26;​ CI:​ 1.05–1.51). Dementia and non-opioid analgesic therapy were positively associated with fracture after both stroke and TIA.

Conclusion:​ Stroke was positively associated with fracture in patients < 80 years, while TIA was positively associated with fracture in patients ≥ 80 years and females. Dementia and analgesic therapy were also associated with fracture after either stroke or TIA.