Risk of Hip/Femur Fracture After Stroke: A Population-Based Case-Control Study

Background and Purpose— Stroke increases the risk of hip/femur fracture, as seen in several studies, although the time course of this increased risk remains unclear. Therefore, our purpose is to evaluate this risk and investigate the time course of any elevated risk. Methods— We conducted a case-control study using the Dutch PHARMO Record Linkage System database. Cases (n=6763) were patients with a first hip/femur fracture; controls were matched by age, sex, and region. Odds ratio (OR) for the risk of hip/femur fracture was derived using conditional logistic regression analysis, adjusted for disease and drug history. Results— An increased risk of hip/femur fracture was observed in patients who experienced a stroke at any time before the index date (adjusted OR, 1.96; 95% CI, 1.65–2.33). The fracture risk was highest among patients who sustained a stroke within 3 months before the index date (adjusted OR, 3.35; 95% CI, 1.87–5.97) and among female patients (adjusted OR, 2.12; 95% CI, 1.73–2.59). The risk further increased among patients younger than 71 years (adjusted OR, 5.12; 95% CI, 3.00–8.75). Patients who had experienced a hemorrhagic stroke tended to be at a higher hip/femur fracture risk compared with those who had experienced an ischemic stroke. Conclusions— Stroke is associated with a 2.0-fold increase in the risk of hip/femur fracture. The risk was highest among patients younger than 71 years, females, and those whose stroke was more recent. Fall prevention programs, bone mineral density measurements, and use of bisphosphonates may be necessary to reduce the occurrence of hip/femur fractures during and after stroke rehabilitation.

[1]  N. Crabtree,et al.  Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: bone adaptation after decreased mechanical loading. , 2000, Bone.

[2]  J. Playfer,et al.  Falls and Parkinson's disease. , 2001, Age and ageing.

[3]  R Mann,et al.  Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis. , 2009, Health technology assessment.

[4]  Keith D Hill,et al.  Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. , 2006, Archives of physical medicine and rehabilitation.

[5]  O. Johnell,et al.  Acute and Long-Term Increase in Fracture Risk After Hospitalization for Stroke , 2001, Stroke.

[6]  T. Tsuji,et al.  Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry. , 1999, Archives of physical medicine and rehabilitation.

[7]  V. Feigin,et al.  Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century , 2003, The Lancet Neurology.

[8]  Jonathan Reeve,et al.  Falls, Fractures, and Osteoporosis After Stroke: Time to Think About Protection? , 2002, Stroke.

[9]  A. Ramnemark,et al.  Fractures after Stroke , 1998, Osteoporosis International.

[10]  E. Barrett-Connor,et al.  Modifiable predictors of bone loss in older men: a prospective study. , 2004, American journal of preventive medicine.

[11]  Frank de Vries,et al.  Reanalysis of two studies with contrasting results on the association between statin use and fracture risk: the General Practice Research Database. , 2006, International journal of epidemiology.

[12]  C. Jagger,et al.  Controlling hypertension and hypotension immediately post stroke (CHHIPS)--a randomised controlled trial. , 2009, Health technology assessment.

[13]  A. Forster,et al.  Incidence and consequences offalls due to stroke: a systematic inquiry , 1995, BMJ.

[14]  E. Warburton,et al.  Rapid long-term bone loss following stroke in a man with osteoporosis and atherosclerosis , 2005, Osteoporosis International.

[15]  S. Sen,et al.  Undertreatment with anti-osteoporotic drugs after hospitalization for fracture , 2004, Osteoporosis International.

[16]  S. Greenland Dose‐Response and Trend Analysis in Epidemiology: Alternatives to Categorical Analysis , 1995, Epidemiology.

[17]  L Nyberg,et al.  Hemiosteoporosis after severe stroke, independent of changes in body composition and weight. , 1999, Stroke.

[18]  C. Cooper,et al.  Antipsychotic use and the risk of hip/femur fracture: a population-based case–control study , 2009, Osteoporosis International.

[19]  C. Cooper,et al.  Use of inhaled and oral glucocorticoids, severity of inflammatory disease and risk of hip/femur fracture: a population‐based case–control study , 2007, Journal of internal medicine.

[20]  M. Dennis,et al.  Fractures After Stroke: Frequency, Types, and Associations , 2002, Stroke.

[21]  Henry L. Lew,et al.  Bone-density changes after stroke. , 2006, American journal of physical medicine & rehabilitation.

[22]  S. Miyano,et al.  Prevention of Secondary Osteoporosis Postmenopause in Hemiplegia , 2001, American journal of physical medicine & rehabilitation.

[23]  A. Ramnemark,et al.  Stroke, a major and increasing risk factor for femoral neck fracture. , 2000, Stroke.

[24]  T. Masud,et al.  Epidemiology of falls. , 2001, Age and ageing.

[25]  O. Johnell,et al.  Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study , 1999, Osteoporosis International.

[26]  P. Vestergaard,et al.  Hypertension Is a Risk Factor for Fractures , 2009, Calcified Tissue International.

[27]  J. Ottervanger,et al.  NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics. , 1998, Archives of internal medicine.

[28]  H. Ucan,et al.  Bone Mineral Density in Patients with Stroke , 2001, American journal of physical medicine & rehabilitation.

[29]  E. Burns Older people in accident and emergency departments. , 2001, Age and ageing.

[30]  T. Wilsgaard,et al.  Walking after Stroke: Does It Matter? Changes in Bone Mineral Density Within the First 12 Months after Stroke. A Longitudinal Study , 2000, Osteoporosis International.