SAT-774 - Post-Stroke Fracture Risk: Intracerebral Haemorrhage Versus Ischaemic Stroke-A Systematic Review and Meta-Analysis

Background: Strokes, occurring with sudden interruption of cerebral blood supply, cause significant mortality and morbidity and can be caused by ischaemic or intracerebral haemorrhage (ICH). Fracture risk in stroke survivors is heightened, due to multiple factors, culminating in falls and skeletal fragility. This is well-described in ischaemic stroke (IS) but not well delineated in ICH, despite comprising 28.8% of strokes, with inconsistent evidence surrounding post-stroke fracture rates depending on stroke aetiology.

Objective: To examine the current literature in post-stroke fracture outcomes in both stroke subtypes.

Methods: A systematic review was conducted and reported in accordance with 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, compared to IS. Additionally, backward citation screening was carried out. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist. A meta-analysis is planned to be conducted.

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.


Conclusion: Based on the included studies, ICH may be associated with higher fracture risk than IS, however the evidence is mixed and a formal meta-analysis is currently pending. The limited number of studies comparing stroke subtypes highlights the need for more robust and well-designed studies. Nevertheless, the included studies showed that fracture risk is increased following both stroke types with poorer bone health outcomes. Overall, these results support the need for a more comprehensive approach to post-stroke bone health assessment and fracture prevention.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*