Incidence and risk factors for stroke after hip fracture: a meta-analysis

Abstract

Hip fractures represent a high burden and are associated with mortality in up to 30% of the cases. Stroke complications can be devastating and increase mortality and disability in elderly patients. This study aimed to determine the overall incidence and risk factors for stroke in patients with hip fractures. A systematic search of the literature using PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases was carried out. Studies have reported the incidence of stroke in patients > 50 years of age with hip fractures. Data were extracted according to PRISMA guidelines (PROSPERO: CRD42023384742). Data were combined using Review Manager version 5.4. A random-effects model was adopted if a significant heterogeneity was observed. The primary outcome was the incidence of stroke in patients with hip fractures. The secondary outcomes of interest included the influence on the incidence of demographic factors, associated conditions, habits, and analytical parameters. Of the 635 initially retrieved studies, 18 were included, with 256,197 patients. The mean age of the patients ranged from 55 to 84 years old. The overall incidence of stroke in patients with hip fracture was 6.72% (95% CI 4.37–9.07%. The incidence of stroke by region was highest in the American continent (8.09%, 95% CI 3.60–12.58%; P > 0.001). Regarding associated conditions diabetes significantly increased the risk of stroke (OR 1.80, 95% CI 1.41–2.30). Respect to patient characteristics, BMI greater than 24.4 and female gender did not significantly increase the risk of stroke: (OR 1.07, 95% CI 0.74–1.56) and (OR 1.15, 95% CI 0.91–1.46). Lastly, lower albumin concentrations were a risk factor for stroke in patients with hip fracture (MD − 3.18, 95% CI − 4.06 to 2.31). In conclusion, the incidence of stroke after hip fracture was 6.72%. The incidence of stroke increases over time, and the closely associated risk factors are diabetes and low albumin level.

Fracture Risk Among Stroke Survivors According to Poststroke Disability Status and Stroke Type

“…36 Moreover, fractures can result in further functional decline, disrupt stroke rehabilitation, and elevate the risk of subsequent stroke. 37,38 The American Heart Association/American Stroke Association and guidelines for adult stroke rehabilitation and recovery recommend a formal fall prevention program during hospitalization for stroke survivors, and that stroke patients discharged to the community participate in exercise programs with balance training to reduce falls. 39 A previous study demonstrated reduced fracture risk with regular exercise following acute stroke.…”

Fracture risk among stroke survivors according to post-stroke disability status and stroke type

“…Delayed rehabilitation of stroke survivors is a risk factor for fracture 36 . Moreover, fractures can result in further functional decline, disrupt stroke rehabilitation, and elevate the risk of subsequent stroke 37,38 . The American Heart Association/American Stroke Association and guidelines for adult stroke rehabilitation and recovery recommend a formal fall prevention program during hospitalization for stroke survivors, and that stroke patients discharged to the community participate in exercise programs with balance training to reduce falls 39 .…”