Risk of fractures after stroke

Abstract

Objective: To determine the risk of fractures after stroke.Methods: Using the Ontario Stroke Registry, we identified a population-based sample of consecutive patients seen in the emergency department or hospitalized with stroke (n 5 23,751) or TIA (n 5 11,240) at any of 11 stroke centers in Ontario, Canada, and discharged alive between July 1, 2003, and March 31, 2012. We compared the risk of low-trauma fractures in patients with stroke vs those with TIA using propensity score methods to adjust for differences in baseline factors. Secondary analyses compared fracture risk poststroke with that in age-/sex-matched controls without stroke or TIA (n 5 23,751) identified from the Ontario Registered Persons Database. Results:The 2-year rate of fracture was 5.7% in those with stroke compared to 4.8% in those with TIA (adjusted cause-specific hazard ratio [aHR] for those with stroke vs TIA 1.32; 95% confidence interval [CI] 1.19-1.46) and 4.1% in age-/sex-matched controls (aHR for those with stroke vs controls 1.47; 95% CI 1.35-1.60). In the cohort with stroke, factors associated with fractures were older age, female sex, moderate stroke severity, prior fractures or falls, and preexisting osteoporosis, rheumatoid arthritis, hyperparathyroidism, and atrial fibrillation.Conclusions: Stroke is associated with an increased risk of low-trauma fractures. Individuals with stroke and additional risk factors for fractures may benefit from targeted screening for low bone mineral density and initiation of treatment for fracture prevention. Stroke is a leading cause of adult disability, and up to two-thirds of stroke survivors have limitations in mobility.1 Stroke may also be associated with declines in bone mineral density and an increased risk of falls, both factors that can predispose to subsequent low-trauma (fragility) fractures. 2-10Previous studies have suggested an up to 4-fold increase in the risk of fractures in those with stroke compared to healthy controls. 7-13 However, it is not known how much of this fracture risk is due to the stroke itself rather than differences in other baseline factors such as age and comorbidity. A better understanding of both the fracture risk attributable to stroke and the specific factors associated with such fractures would allow for improved screening, prevention, and treatment of osteoporosis and fractures following stroke.We used data from a clinical stroke registry in Ontario, Canada, linked with administrative data, to evaluate the risk of fractures in patients with acute stroke compared to those with TIA. In order to focus on the contribution of stroke (rather than baseline comorbid conditions) to fracture risk, we selected patients with TIA as our reference population, as they are anticipated From the Institute for Clinical Evaluative Sciences

Bone mineral density and fragility fractures in stroke patients

“…Analysis of Ontario Stroke Registry (23751 patients were hospitalized with stroke in 2003-2012) [13] also showed that 2-years risk for any low-trauma fracture was lower (HR = 1.32, 95 % CI 1.19-1.46), than for hip fracture (HR = 1.57, 95 % CI 1.35-1.83). In addition, females had greater risk of low-trauma fracture than males (HR = 1.72, 95 % CI 1.53-1.94).…”

“…The risk of osteoporotic fracture increases with post-stroke duration, age of patients (old age), female sex, stroke severity, a positive history of previous fractures or falls, preexisting osteoporosis and concomitant diseases (rheumatoid arthritis, hyperparathyroidism, etc.) [11,13,19]. Despite the prevalent bone loss in the upper extremities in patients with stroke, literature review has demonstrated that hip fracture is the most common osteoporotic fracture [12,13,19].…”

“…[11,13,19]. Despite the prevalent bone loss in the upper extremities in patients with stroke, literature review has demonstrated that hip fracture is the most common osteoporotic fracture [12,13,19].…”

“…The retrospective analysis of Swedish register [13] that analyzed the data of patients from 1987 to 1996 years (273 000 individuals were hospitalized with stroke) showed that the risks of low-trauma fractures were higher in women than in men. This risk decreased with the age of the patient and time since stroke; however it was always higher than age-and sex-matched controls, except for patients over the age of 80 years.…”

“…Additionally, numerous literature data confirm that patients with stroke have an increased risk of osteoporotic fractures; however, the information about their incidence differs significantly [11][12][13][14]. Furthermore, most studies were performed in Western and Asian countries, but studies among the Ukrainian population have not yet been conducted.…”