Association between post-stroke disability and 5-year hip-fracture risk: The Women's Health Initiative

Northuis, Carin; Crandall, Carolyn J.; Margolis, Karen L.; Diem, Susan J.; Ensrud, Kristine E.; Lakshminarayan, Kamakshi

doi:10.1016/j.jstrokecerebrovasdis.2020.104976

Cited by 13 publications

(16 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…( 10‐12,18 ) In contrast, it is generally agreed that patients with stroke, especially those with persisting disabilities, have increased risk of first‐time hip fracture. ( 19‐22 ) Since stroke history has been proven to impede postfracture rehabilitation, ( 23 ) we expected previous studies to report an even higher risk of recurrent fracture among stroke survivors. However, as patients with stroke history are a very heterogenous group—some with good and some with poor mobility—the reported contradictory results on the association between stroke and recurrent fracture may be a result of varying poststroke mobility.…”

Section: Introductionmentioning

confidence: 99%

Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study

Hjelholt

Brynningsen

Andersen

et al. 2020

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Considerable uncertainty prevails regarding risk factors for recurrent fracture among older patients with hip fracture. We aimed to investigate the relationship between prefracture stroke history, baseline mobility, and the risk of recurrent hip fracture. This cohort study was based on the Danish Multidisciplinary Hip Fracture Registry, 2011Registry, -2018. We estimated cumulative incidence (competing risk of death) of recurrent hip fracture and major osteoporotic fractures within 1 and 2 years comparing patients with/ without prefracture stroke history. Analyses were performed overall and stratified on baseline mobility status (good mobility: Cumulated Ambulation Score ≥ 5 versus poor mobility: Cumulated Ambulation Score < 5). Using Cox regression, adjusted cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were obtained. The 1-year cumulative incidence was 4.6% (95% CI: 3.9-5.4) among patients with stroke history and 4.3% (95% CI: 4.1-4.5) among patients without stroke history. For patients with good mobility, the cumulative incidence of recurrent hip fracture was 5.8% (95% CI: 4.3-7.5) versus 3.7% (95% CI: 3.4-4.0) for patients with versus without stroke history. Corresponding numbers for patients with poor mobility were 4.4% (95% CI: 3.6-5.5) and 5.0% (95% CI: 4.7-5.3). Stroke history was associated with an adjusted HR of 1.55 (95% CI: 1.15-2.10) for recurrent fracture among patients with good mobility. In contrast, no association was observed among patients with poor mobility (adjusted HR 0.88 [95% CI: 0.70-1.10]). The associations were attenuated after 2 years of follow-up and for major osteoporotic fractures. In conclusion, stroke history was associated with slightly higher risk of recurrent fracture among patients with first-time hip fracture in the overall analysis, although the CI included a null result. The association was modified by baseline mobility: Patients with stroke history and good mobility had a markedly higher risk, whereas patients with stroke and poor mobility did not.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study

Hjelholt

Brynningsen

Andersen

et al. 2020

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

show abstract

“…Based on the sensitivity analyses, our results indicate the excess mortality among hip fracture patients with stroke to be more pronounced if the stroke is of higher severity and if it has occurred within 6 months. These patients have previously been highlighted as the group with the highest risk of sustaining a hip fracture, 9 emphasizing the importance of clinical attention on preventing falls and fractures in these subgroups of patients.…”

Section: Discussionmentioning

confidence: 99%

“… 5–8 The highest risk is found among the most disabled patients and in those with recent stroke. 9 Consequently, around 15% of patients with hip fracture have a history of stroke. 10 Despite this knowledge, a previous report showed that stroke survivors were infrequently screened and treated for osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

The Interaction Effect Between Previous Stroke and Hip Fracture on Postoperative Mortality: A Nationwide Cohort Study

Hjelholt¹,

Johnsen²,

Brynningsen³

et al. 2022

CLEP

View full text Add to dashboard Cite

“…Epidemiological data on hip fractures in stroke patients has been limited by geographical variation in the cohort of patients studied and the retrospective nature of most of the studies [8][9][10][11][12][13]. In addition, the findings have not been generalizable as they were mostly carried out on single population groups.…”

Section: Epidemiologymentioning

confidence: 99%

“…More recently, Northius et al, in their review of a cohort of women obtained from the Women's Health Initiative (WHI) register, found that the absolute 10 year probability of sustaining a hip fracture, calculated using the FRAX (UK) tool without a bone mineral density (BMD), was associated with increased radiological identification of index hip fractures at five years post-stroke [13]. The effect was independent of post-stroke mortality [13].…”

Section: Epidemiologymentioning

confidence: 99%

Hip Fractures in Elderly Stroke Patients - The Role of Sarcopenia and Osteoporosis

Obiechina¹,

Michael²,

Nandi³

et al. 2020

IJCEMS

View full text Add to dashboard Cite

Both hip fractures and stroke are common in elderly patients and hip fractures are especially prevalent in elderly stroke patients. This literature review is an attempt to explore the evidence for strategies to reduce hip fractures in stroke patients, the role of sarcopenia and osteoporosis in causing them and current and potential management strategies. A narrative approach was adopted in reviewing the evidence available on hip fractures in stroke patients, with regard to their incidence and prevalence, the role of sarcopenia and osteoporosis in their genesis and the evidence available for hip fracture prevention in stroke patients. I also attempt to explore the potential role of targeting muscle and bone as one unit in future therapeutic strategies. Although there are encouraging results from clinical trials on therapeutic interventions to prevent hip fractures in stroke patients, larger, more robustly designed studies are needed to validate many of the findings. Some evidence exists that suggest that hip fractures risk can be reduced in stroke patients but the findings need validation in larger more robust trials. Moreover it is clear that sarcopenia and osteoporosis are implicated in hip fractures in stroke and non-stroke elderly patients. A consensus on the definition of sarcopenia would also aid clarification of findings from studies.

show abstract

Association between post-stroke disability and 5-year hip-fracture risk: The Women's Health Initiative

Cited by 13 publications

References 43 publications

Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study

Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study

The Interaction Effect Between Previous Stroke and Hip Fracture on Postoperative Mortality: A Nationwide Cohort Study

Hip Fractures in Elderly Stroke Patients - The Role of Sarcopenia and Osteoporosis

Contact Info

Product

Resources

About