Clopidogrel May Increase Fracture Risk in Patients Who Have Had a Stroke

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http://www.docguide.com/clopidogrel-may-increase-fracture-risk-patients-who-have-had-stroke?hash=7e422beb&eid=35318&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c
Patients who have had a stroke, who are at an already increased risk for fractures, may be at further increased risk if they are being treated with the platelet-inhibitor clopidogrel, according to a retrospective, cohort study presented at the American Society of Bone and Mineral Research (ASBMR) 2013 Annual Meeting.
“Clinicians may not take care of patients’ bone health when they present with a stroke,” noted lead author Niklas RyeJørgensen, MD, PhD, Copenhagen University Hospital Glostrup, Glostrup, Denmark, speaking here on October 5. Most patients who have had a stroke, he added, receive platelet inhibitor therapy with clopidogrel, which has been shown to be associated with an increased risk of fracture.
Dr. Jorgensen and colleagues included 77,503 Danish patients who had been prescribed clopidogrel during the years 1996 to 2008 as exposed subjects. For each of these exposed subjects, 3 subjects of the same age and gender were randomly selected as controls (n = 232,510).
Patients treated with clopidogrel had more strokes compared with the control group (1.2% vs 0.9%, respectively), more ischaemic strokes (9.3% vs 2.6%), and more transient ischaemic attacks (TIAs) (7.2% vs 2.3%).
Patients who have had a stroke had a significantly increased risk of fractures, both in the haemorrhagic stroke group (hazard ratio [HR]: 1.34, P< .001) and the ischaemic stroke group (HR: 1.54, P< .001).
Patients who have had a TIA also had an increased risk of fractures (HR: 1.28, P< .001), as did clopidogrel users (HR: 1.05, P< .001), although the researchers note that the contribution of clopidogrel treatment was much less than the contribution of the stroke itself.
A number of factors contributed to an increased risk of fractures in patients who have had a stroke, the researchers outlined. Patients who have had a stroke have several risk factors for bone loss, including decompensation, treatment with agents that can lead to increased bone resorption (and thereby bone loss), vitamin D insufficiency, and an increased risk of falls, primarily because of changes in these values and changes in muscular function.
“We should definitely recommend to clinicians to take care of bone health in stroke patients,” Dr. Jorgensen concluded.
Patients in this study were culled from 3 databases in Denmark: the National Hospital Discharge Register, the Psychiatric Central Register, and the National Pharmacological Database of the Danish Health & Medicines Agency.