Post stroke fracture risk intracerebral haemorrhage versus ischaemic stroke a systematic review and meta analysis — ASN Events
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Post stroke fracture risk intracerebral haemorrhage versus ischaemic stroke a systematic review and meta analysis (#371)

Chrislyn Ng 1 , Connor Burley 2 , Jakub Mesinovic 3 , Peter Ebeling 1 , Gabrielle Stokes 2 4 , Frances Milat 1 2 4 , Mícheál Ó Breasail 1
  1. Monash University, Melbourne, Victoria, Australia
  2. Monash Health, Melbourne, Victoria, Australia
  3. Deakin University, Melbourne, Victoria, Australia
  4. Hudson Institute of Medical Research, Melbourne, Victoria, Australia

Stroke comprises two subtypes — intracerebral haemorrhage (ICH) and ischaemic stroke (IS) — with ICH accounting for 28.8% of strokes and contributing to significant mortality and morbidity. Heightened fracture risk is a well-established complication of stroke, arising from skeletal fragility and falls. However, evidence on how post-stroke fracture rates differ by aetiology remains inconsistent. We examined the literature on post-stroke fracture outcomes across both subtypes.

A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. We searched Ovid MEDLINE, Scopus, Cochrane Database and Embase to November 2025 for observational studies reporting post-stroke fracture outcomes in adults with confirmed ICH, compared with IS. Backward citation screening was performed, and risk of bias assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A meta-analysis is currently underway.

Fifteen studies were identified: five analysed cumulative incident fractures, three sub-analysed multiple fracture sites, four hip fractures, and one 'low-trauma' fractures; the remaining two used stroke subtype only as a covariate and were uninformative. Findings were inconsistent as to whether IS or ICH conferred greater fracture risk, with only four reporting a statistically significant difference. Three reported an increased fracture rate in ICH. Two studies (1, 2) compared each subtype against a matched non-stroke control rather than directly, whereas one (3) reported increased overall fracture rates in ICH (hazard ratio 1.93; 95% CI 1.11–3.34) on direct comparison with IS. One study reported higher fracture rates in the alternative subtype.

Some evidence suggests ICH may carry a higher fracture risk than IS, though a formal meta-analysis is pending. Both subtypes are clearly associated with increased fracture risk and poorer bone health. The small number of comparative studies highlights the need for more robust research and supports a generic approach to bone health assessment and fracture prevention.

  1. Zheng JQ, Lai HJ, Zheng CM, Yen YC, Lu KC, Hu CJ, Lee HH, Wang YH. Association of stroke subtypes with risk of hip fracture: a population-based study in Taiwan. Arch Osteoporos. 2017;12(1):104.
  2. Lee D, Cho IY, Chang WH, Yoo JE, Choi HL, Park J, Shin DW, Han K. Fracture Risk Among Stroke Survivors According to Poststroke Disability Status and Stroke Type. Stroke. 2024;55(6):1498–1506.
  3. Lisabeth LD, Morgenstern LB, Wing JJ, Sanchez BN, Zahuranec DB, Skolarus LE, Burke JF, Kleerekoper M, Smith MA, Brown DL. Poststroke fractures in a bi-ethnic community. J Stroke Cerebrovasc Dis. 2012;21(6):471–477.