Associations between stroke type, stroke severity, and pre-stroke osteoporosis with the risk of post-stroke fracture: A nationwide population-based study

Wang, Hung-Ping; Sung, Sheng-Feng; Yang, Hsin-Yi; Huang, Wan‐Ting; Hsieh, Cheng‐Yang

doi:10.1016/j.jns.2021.117512

Cited by 13 publications

(25 citation statements)

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“…However, there are significantly more predictors of fractures in patients who have had cerebral stroke than in subjects without neurological and cardiac pathology, and therefore it is currently impossible to explain the high risk of fractures only by changes in BMD. No direct correlation between the severity of neurological deficits and fractures was found, on the contrary, patients with mild neurological deficits have the highest risk of fractures, which is due to greater activity and, therefore, a greater risk of falls [13]. However, determining of BMD and its correcting if necessary is an effective and promising way to reduce the risk of fractures.…”

Section: Discussionmentioning

confidence: 97%

Bone mineral density and its relationship with body composition indices in stroke patients

Bystrytska

2022

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Background. Stroke and osteoporosis with its complications are age-related diseases that mainly affect the elderly. The aim of the study was to determine the bone mineral density (BMD, fat and lean mass and their association in stroke patients. Materials and methods. Eighty-six stroke patients and 86 age- and sex-matched individuals without neurological disorders as a comparison group were examined. BMD, lean and fat mass were determined using dual-energy X-ray absorptiometry. Results. Men and women with stroke had a significantly higher frequency of osteoporosis than the comparison group (14.2 vs. 2.3 %; 20.5 vs. 4.4 %, respectively). BMD in women with a stroke was lower at the level of all examined areas, in men; differences were registered at the proximal femur and the total body. In men with stroke, significantly lower lean mass index (17.9 ± 1.5 and 19.2 ± 1.8 kg/m2; p < 0.05) and the appendicular lean mass index (7.5 ± 0.4 and 8.5 ± 1.0 kg/m2; p < 0.05) were found, and in women — no significant differences in body composition indices were found, however, the frequency of sarcopenia was significantly higher in both men (28.6 vs. 9.5 %, p < 0.05) and women (15.9 vs. 2.3 %, p < 0.05). In men of both groups, positive correlations between total body BMD and lean mass were registered. The dependence of BMD of different areas on fat and lean mass was obtained in stroke women, in contrast to men, in whom the influence of fat mass on BMD was not found. Conclusion. The stroke leads to changes in bone mineral density and lean (muscle) mass and therefore is a risk factor for the development of osteoporosis and sarcopenia.

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Section: Discussionmentioning

confidence: 97%

Bone mineral density and its relationship with body composition indices in stroke patients

Bystrytska

2022

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“…The likelihood of using these two measures was even lower in patients with greater stroke severity. Our previous study showed an inverse association between stroke severity and the risk of post-stroke fractures ( 16 ). We speculate that patients with moderate or severe stroke were more likely to be wheelchair or bed bound and thus experienced fewer falls and fractures, which further decreased their chances of using BMD testing and osteoporosis treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The stroke cohort consisted of patients aged 55 years and older who were hospitalized with a principal discharge diagnosis of hemorrhagic or ischemic stroke between 2005 and 2017 from the LGTD 2000. We only included those aged 55 years or above because a significant increase in the risk of post-stroke fractures was observed after this age in our previous study ( 16 ). The hospitalization was defined as the index hospitalization, and the index date was defined as the admission date of the index hospitalization.…”

Section: Methodsmentioning

confidence: 99%

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Utilization of screening and treatment for osteoporosis among stroke survivors

Hsu

Sung²,

Yang³

et al. 2022

Front. Endocrinol.

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BackgroundStroke survivors are prone to osteoporosis and fractures. However, bone mineral density (BMD) testing and osteoporosis treatment were underutilized in patients with recent stroke. We aimed to examine whether stroke has an impact on the utilization of BMD testing and osteoporosis treatment as well as the determinants of their utilization in stroke patients using nationwide population-based data in Taiwan.MethodsWe identified patients aged 55 years and older who were hospitalized for hemorrhagic or ischemic stroke as the stroke cohort, and age- and sex-matched patients hospitalized for reasons other than stroke, fracture, or fall as the non-stroke cohort. We used the Fine-Gray sub-distribution hazard competing risk regression model to determine the predictors for BMD testing and osteoporosis treatment.ResultsA total of 32997 stroke patients and 32997 age- and sex-matched controls comprised the stroke and non-stroke cohorts, respectively. BMD testing and osteoporosis treatment were performed in 1.0% and 5.2% of the stroke patients, respectively, within one year after hospitalization while these measures were performed in 0.8% and 4.7% of the controls. Stroke patients were more likely to receive BMD testing (adjusted hazard ratio [HR] 1.33; 95% confidence interval [CI] 1.11–1.58) and osteoporosis treatment (adjusted HR 1.19; 95% CI 1.11–1.29). Female sex, osteoporosis, prior BMD testing, and low-trauma fractures after stroke increased the likelihood of using BMD testing and osteoporosis treatment whereas greater stroke severity reduced the likelihood of receiving both measures.ConclusionsBoth BMD testing and osteoporosis treatment were underutilized among stroke survivors even though they had a higher chance of receiving both measures than non-stroke patients.

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“…However, it is also present, albeit at a lesser degree, in the non-paretic limb [ 6 ]. A recent study showed that milder stroke and osteoporosis, but not stroke type, to be significantly associated with fracture risk [ 7 ]. Despite this evidence since 1957, patients with recent strokes were still not adequately screened for osteoporosis [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Non-pharmacological interventions for bone health after stroke: A systematic review

et al. 2022

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Objective To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients. Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021. Methods A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis. Results Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported. Conclusion There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

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Associations between stroke type, stroke severity, and pre-stroke osteoporosis with the risk of post-stroke fracture: A nationwide population-based study

Cited by 13 publications

References 44 publications

Bone mineral density and its relationship with body composition indices in stroke patients

Bone mineral density and its relationship with body composition indices in stroke patients

Utilization of screening and treatment for osteoporosis among stroke survivors

Non-pharmacological interventions for bone health after stroke: A systematic review

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