Falls and Osteoporosis Post-Stroke

Falls are a common and serious, but potentially preventable, problem after stroke. Avoiding falls requires balance, which is a fluid and dynamic physical skill. There are a number of perceptual, neurological, and mechanical mechanisms underlying our ability to balance, and they are complex and heterogeneous. Depending on where strokes occur in the brain, balance may be affected in different ways. It is important to identify stroke patients who are at risk of falls in order to optimize prevention, and a number of stroke-specific risk factors have been identified, but the available assessment scales have only limited sensitivity and specificity. If management of falls risk in stroke is to be effective, assessments have to identify the precise and individual mechanisms underlying balance problems, and then specific management has to be targeted at these deficits. The consequences of falls after stroke can be severe and include loss of confidence and loss of independence, as well as serious injury including fractures. Stroke patients are at greater risk of osteoporosis, particularly on the hemiplegic side, which occurs rapidly following paresis. Management of falls risk post-stroke should also include timely assessment of bone health and the associated fracture risk.