Increased risk of stroke among hip fracture patients: a nationwide cohort study

Tsai, Chun‐Hao; Lin, Cheng‐Li; Hsu, Hsing-Chi; Chung, Wei‐Sheng

doi:10.1007/s00198-014-2919-7

Cited by 17 publications

(19 citation statements)

References 33 publications

(33 reference statements)

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“…For symptomatic stroke, a registry‐based study from Taiwan reported an absolute risk of 4% within 1 year among 2101 hip fracture patients . A second study from this source estimated an incidence rate of 35 per 1000 person‐years among 6013 hip fracture patients during a mean follow‐up of 4 years . This was higher than the 1‐year risk of 2.18% estimated in our study.…”

Section: Discussioncontrasting

confidence: 68%

“…Nevertheless, our relative risk estimates for stroke are generally consistent with the findings of these two studies. They observed a relative risk of 55% within 1 year and 46% during 5 years to a maximum of 12 years of follow‐up. We extended these findings by showing that risk of stroke persists up to 10 years following hip fracture, but not beyond this period—suggesting the need for targeting preventive treatment for stroke during and shortly after hospital admission to reduce stroke risk within 1 year, as well as for providing long‐term preventive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Post–hip fracture risk of symptomatic MI, examined in a single study from Taiwan, was increased 29% compared with general population during the median follow‐up of 3.2 years . With respect to stroke, also based on evidence from Taiwan, Kang and colleagues observed a 55% increased 1‐year risk, whereas Tsai and colleagues found a 46% increased risk of stroke approximately 5 years following hip fracture compared with a nonfracture cohort. The earlier studies leave unanswered questions because of their short follow‐up; small size; no estimation of relative risks; variable definitions of MI and stroke, and lack of detailed data on comorbidity .…”

Section: Introductionmentioning

confidence: 99%

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Hip Fracture, Comorbidity, and the Risk of Myocardial Infarction and Stroke: A Danish Nationwide Cohort Study, 1995–2015

Pedersen

Ehrenstein

Szépligeti

et al. 2017

Journal of Bone and Mineral Research

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We evaluated risks of MI and stroke in elderly patients with hip fracture compared with the general population. We also examined the interaction between hip fracture and comorbidity with respect to risks of MI or stroke, defined as excess of risk explained by combining risks of hip fracture and comorbidity. We conducted a population-based cohort study using Danish health registries, in 1995 to 2015 including 110,563 hip fracture patients and 552,774 members of the comparison cohort from the general population. Thirty-day cumulative incidences of MI were 1.15% among patients with hip fracture and 0.09% in the general population (adjusted hazard ratio [aHR] = 12.97; 95% confidence interval [CI], 11.56 to 14.55). Thirty-day cumulative incidences of stroke were 2.16% for hip fracture patients and 0.21% in the general population (aHR = 9.42; 95% CI, 8.71 to 10.19). During the 31 to 365 days following hip fracture, the aHR for MI was 1.05 (95% CI, 0.97 to 1.14) and remained at this level during the remainder of follow-up (maximum of 20 years). The aHR for stroke was 1.29 (95% CI, 1.22 to 1.35) during the 31 to 365 days following hip fracture, remained elevated for up to 10 years, and then decreased to the general population level. The aHRs for MI and stroke were increased for both men and women, and in all age and comorbidity groups. During the first 30 days, up to 76% of MI and stroke risk was attributable to interaction between hip fracture and comorbidity. Patients with hip fracture are at increased risk of both MI and stroke up to 1 year following the fracture. Risk of stroke, but not of MI, was elevated during up to 10 years postfracture. Although the absolute risks were low, our finding underscores the importance of targeting multimorbidity, including prevention and adequate treatment, to improve the prognosis of hip fracture patients. © 2017 American Society for Bone and Mineral Research.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hip Fracture, Comorbidity, and the Risk of Myocardial Infarction and Stroke: A Danish Nationwide Cohort Study, 1995–2015

Pedersen

Ehrenstein

Szépligeti

et al. 2017

Journal of Bone and Mineral Research

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“…7 Within the first year of hip surgery, about 4% patients will suffer from stroke. Currently in the US, there are six million hip fractures/year, 6,8 that will increase with the population aging. As advanced age is a risk factor for both stroke and fracture, it is imperative to understand the neurobiologic underpinnings for the association of these two conditions on the trajectory of aged-related cognitive decline.…”

Section: Introductionmentioning

confidence: 99%

Fracture shortly before stroke in mice leads to hippocampus inflammation and long-lasting memory dysfunction

Wei

Lyu

et al. 2019

J Cereb Blood Flow Metab

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Cognitive impairment occurs in stroke and hip fracture patients. In mice, bone fracture (BF) exacerbates stroke-related neuronal damage and sensorimotor dysfunction. We hypothesize that BF exacerbates post-stroke cognitive impairment. Adult mice were randomly assigned into BF, stroke, BF+stroke (BF 6 h before stroke), and control (sham operated) groups. Memory function was evaluated weekly for eight weeks by Y maze test and at eight weeks post-surgeries by novel object recognition (NOR) test. The neuronal damage and inflammation in hippocampus were analyzed three days and eight weeks after the surgeries. In Y maze test, BF+stroke mice started making fewer alternations than controls two weeks after the surgeries. Significant difference between BF+stroke and stroke groups started at five weeks post-injury and continued to the end of the experiment. In NOR test, BF+stroke group spent less time on novel objective than that of other groups. Cx3cr1+ cells and CD68+ cells accumulated in the stratum lacunosum moleculare (SLM) on the ipsilateral side of stroke injury in stroke and BF+stroke mice. BF+stroke mice had a higher ratio of ipsilateral/contralateral Cx3cr1+ cell-density than that of stroke mice. Therefore, BF shortly before stroke exacerbates hippocampal inflammation and causes long-lasting memory dysfunction.

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“…The patients in the LHID2000 were diagnosed according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. This database has been reliably used in our previous studies 17,18 . This cohort study was approved by the Institutional Review Board of Tsaotun Psychiatric Center.…”

Section: Data Sourcementioning

confidence: 99%

Increased risk of stroke in patients with osteoarthritis: a population-based cohort study

Hsu

Lin

et al. 2017

Osteoarthritis and Cartilage

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Increased risk of stroke among hip fracture patients: a nationwide cohort study

Abstract: Hip fracture is independently associated with a subsequent risk of stroke.

Cited by 17 publications

References 33 publications

Hip Fracture, Comorbidity, and the Risk of Myocardial Infarction and Stroke: A Danish Nationwide Cohort Study, 1995–2015

Hip Fracture, Comorbidity, and the Risk of Myocardial Infarction and Stroke: A Danish Nationwide Cohort Study, 1995–2015

Fracture shortly before stroke in mice leads to hippocampus inflammation and long-lasting memory dysfunction

Increased risk of stroke in patients with osteoarthritis: a population-based cohort study

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