The Epidemiology of Fracture in Patients with Acute Ischemic Stroke in Korea

Abstract

Background Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. Methods Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. Results Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17–1.30), women (HR, 1.74; 95% CI, 1.54–1.97), previous fracture (HR, 1.72; 95% CI, 1.54–1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27–1.63) were independent risk factors of post-stroke fracture. Conclusion The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.

Characteristics of fracture in patients who firstly starts kidney replacement therapy in Korea: a retrospective population-based study

“…Based on the Korean population-based hip-fracture study This study was consistent with previous reports indicating that the HD group had the highest IR of fractures among all ESKD patients 2,3,7,12 . Thus, we reinforced the significance of KRT modality as a risk factor for fracture in the presence of other comorbidities and specific medications 4,7,8,10,[12][13][14][15] . Based on our data, further attention is needed to prevent fractures in dialyzed patients, especially those on HD.…”

“…We may presume that patients who survived after stroke are at high risk of falls and fractures. Indeed, patients with stroke carried a fourfold increased risk of fracture compared with healthy population 15 . Furthermore, patients with chronic lung disease are more likely to experience fractures, considering the use of inhaled corticosteroids or oral steroids, and their disability to ambulate leading to disuse osteoporosis and fragility fractures 24 .…”

Change in Bone Mineral Density in Stroke Patients with Osteoporosis or Osteopenia

“…Changes in BMD after stroke have reportedly been correlated with age, degree of paralysis, duration of paralysis, blood calcium level, vitamin D concentration, and vitamin K concentration during the first year, and degree of paralysis and blood vitamin D concentrations after two years [ 21 ]. The risk of fractures increases after a stroke; in particular, FN fracture occurrence is 2–4 times higher in stroke patients compared with the general population of the same age [ 4 , 5 ]. As such, stroke patients are more likely to develop osteoporosis, which increases the incidence of spine or FN fractures, which in turn increases the length of hospital stay and medical expenses.…”

“…Bone loss begins immediately after stroke, continues until 3–4 months after onset, and progresses at a slower rate until one year after onset [ 3 ]. Stroke patients fall frequently due to paralysis and loss of balance, and as a result, femur fractures are 2–4 times more common [ 4 , 5 ]. Most fractures after stroke occur in the hemiplegic side of the body because the BMD in this side decreases by 4.6–14% compared with the unaffected side [ 6 ].…”

Loganin attenuates neuroinflammation after ischemic stroke and fracture by regulating α7nAChR‐mediated microglial polarization

“…Death rates from stroke rise sharply with age, and fractures increase the risk of death for stroke survivors. People who have a stroke are reported to have an approximately four‐fold increased risk of fracture compared to healthy people 3 . A previous study showed that fractures after ischemic stroke in mice exacerbate stroke‐induced neurological impairment and behavioral deficits, indicating that post‐stroke fractures can aggravate stroke damage to the body 4 .…”