Stroke increases the risk of hip fracture: a systematic review and meta-analysis

Luan, Liqin; Li, R.; Wang, Z.; Hou, Xiaoyan; Gu, Weijun; Wang, X.; Yan, Shushan; Xu, Dongmei

doi:10.1007/s00198-016-3632-5

Cited by 30 publications

(21 citation statements)

References 41 publications

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“…For more comprehensive lists of risk factors we refer to the literature [41]. Three German studies [42][43][44] support earlier findings [45][46][47] of an increased risk of hip fractures in people with Parkinson's disease, after stroke, or in patients with dementia.…”

Section: Risk Factorssupporting

confidence: 63%

Epidemiology of hip fractures

et al. 2018

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Background Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature. Methods The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures. Results Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10–40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures. Conclusion The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors. Electronic supplementary material The online version of this article (10.1007/s00391-018-1382-z) contains supplementary material, which is available to authorized users.

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Section: Risk Factorssupporting

confidence: 63%

Epidemiology of hip fractures

et al. 2018

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“…Both stroke and hip fracture are associated with significant disability, morbidity and mortality 6 29 56. People who suffered stroke are at much higher risk of developing hip fractures within 2 years following stroke, as compared with general population without stroke 11 57.…”

Section: Discussionmentioning

confidence: 99%

“…It contributes to disability, morbidity and mortality due to functional loss, and further imposes a considerable socioeconomic burden on society and contributes to deterioration in quality of life 3–5. Stroke is a major risk factor for hip fracture that increases the risk of hip fracture by two to four times 6 7. Jørgensen et al 8 reported that the bone mineral density decreased remarkably soon after stroke.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Stroke is a major risk factor for hip fracture that increases the risk of hip fracture by two to four times. 6 7 Jørgensen et al 8 reported that the bone mineral density decreased remarkably soon after stroke. In addition, stroke increases the risk of falls; both these conditions predispose to hip fractures [9][10][11] and contribute to further decrease in survival rates and reduced recovery of independent mobility after stroke.…”

Section: Introductionmentioning

confidence: 99%

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Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

et al. 2017

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ObjectivesThis study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.SettingA population-based, propensity-matched cohort study was conducted on the basis of Taiwan’s National Health Insurance Research Database.ParticipantsPatients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.Outcome measuresHRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.ResultsOverall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).ConclusionsThe long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

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“…(10) In a meta-analysis of 11 studies, the risk of hip fracture was increased after a stroke (relative risk [RR] ¼ 2.06, 95% CI 1.68 to 2.52). (11) Hip fracture is particularly common immediately after the stroke; in one study, the hazard ratio was 3.9 within 1 month and 1.5 in the first 5 years after stroke. (12) Recurrent falls (and the fear of falling) are more common after stroke.…”

Section: Parkinson's Diseasementioning

confidence: 98%

Risk and Prevention of Fracture in Patients With Major Medical Illnesses: A Mini-Review

Cummings

Eastell

2016

Journal of Bone and Mineral Research

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Patients with several medical conditions, including Parkinson's disease, recent stroke, HIV, and heart failure, have a high risk of hip fracture. These patients will also have more severe consequences of a hip fracture, including a greater chance of dying and more prolonged disability. Together, there are nearly as many patients with medical conditions that substantially increase the risk of hip fracture as there are people with osteoporosis by femoral neck bone mineral density (BMD). The contributions of falling and decreased bone mass to the increased risks with these conditions are not certain. Although there are few data about whether and what type of treatments these patients receive to prevent fracture, it is likely that few receive pharmacologic treatments that have been shown to reduce the risk of hip fracture. There is a need to show that drug treatments that strengthen bone also reduce fracture risk in patients whose risk may be owing in greater part to traumatic falls than osteoporosis. Assuming that treatments are efficacious in these patients, there is a major opportunity to substantially reduce the incidence and consequences of hip fracture by reaching more of them with drug treatments to reduce the risk of hip fracture. This will require engagement of specialists who have little expertise and perhaps limited interest in preventing fractures, or new approaches to delivering drug treatments to prevent fracture directly to the patients at risk.

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Stroke increases the risk of hip fracture: a systematic review and meta-analysis

Cited by 30 publications

References 41 publications

Epidemiology of hip fractures

Epidemiology of hip fractures

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

Risk and Prevention of Fracture in Patients With Major Medical Illnesses: A Mini-Review

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