Transient Ischemic Attack Significantly Increases New Fracture Risk in Osteoporotic Geriatric Populations Within 1 Year

Background and/or Objectives: Osteoporosis increases fracture risk in older adults, leading to significant morbidity and mortality. While transient ischemic attacks (TIAs) are known to affect neuromuscular function and balance, their impact on fracture risk in osteoporotic patients is underexplored. This study investigates whether older adults ≥65 years with osteoporosis who experience a TIA have a higher 1-year fracture risk than those without TIA.

Design: Retrospective cohort study

Setting : TriNetX Database Research Network

Participants : 2 cohorts were analyzed: Cohort A included 67,979 osteoporotic patients aged ≥65 years with a prior TIA, while Cohort B included 1,734,019 osteoporotic patients aged ≥65 years without a history of TIA. After 1:1 propensity score matching for demographics (age, sex, race, ethnicity) and relevant comorbidities, each cohort contained 65,359 patients.

Interventions: Not applicable.

Main Outcome Measures: Outcome measures included new fractures of the proximal femur, distal femur, pelvis, ankle, distal forearm, proximal humerus, rib, cervical vertebra, thoracic vertebra, and lumbar vertebra within 1-year post-TIA. Relative risk and odds ratios were calculated for each outcome within TriNetX. Statistical significance was set to p< 0.05.

Results: Osteoporotic patients aged ≥65 years who experience a TIA were associated with a significantly higher 1-year risk of pelvic fractures (RR=1.196, p=0.0097), rib fractures (RR=1.527, p=0.0001), distal forearm fractures (RR=1.305, p=0.0005), proximal humerus fractures (RR=1.206, p=0.0157), and lumbar vertebral fractures (RR=1.11, p=0.0434), when compared with osteoporotic patients aged ≥65 years without TIA. The remaining fracture sites showed no statistically significant difference between the two groups.

Conclusions: Older adults (≥65 years) with osteoporosis who experience a TIA are at a significantly higher risk of sustaining pelvic, rib, distal forearm, proximal humerus, and lumbar vertebra fractures within 1 year of TIA diagnosis. These patients may have neuromuscular deficits, balance issues, and weakness that increase fall risk. Early fall prevention, strength and balance training, and adaptive interventions should be implemented to reduce fracture risk and improve independence.