Risk of hip fracture following stroke, a meta-analysis of 13 cohort studies

Abstract

This study systematically reviews prospective and retrospective cohort studies evaluating the risk of hip fracture following stroke. Stroke survivors are at high risk of hip fracture and had a 1.5-fold increased risk compared to stroke-free men and women of the same age. Hip fracture often occurs in ageing and female stroke patients. We performed a meta-analysis to summarize evidence from prospective and retrospective cohort studies about the risk of hip fracture following stroke. We identified English and non-English publications in MEDLINE and EMBASE using stroke and fracture as keywords to 31 December 2015. The data of the incidence of hip fracture were extracted to calculate raw incident rate in stroke survivors as well as risk of hip fractures in strokes comparing populations using a random-effects model. Subgroup analyses were performed to identify the potential influence of some factors. Six prospective and seven retrospective cohort studies were included, involving 512,214 stroke patients with 22,559 hip fractures. The pooled prevalence of hip fractures was 4.87 % (95 % CI, 4.05 to 5.68 %) in stoke patients. We conducted subgroup analysis according to sex, age, duration of follow-up, study design, and region, which showed that female (vs. male) stroke patients older than 70 years (vs. those less than 70 years) and duration of follow-up more than 2 years (vs. those less than 2 years) have higher proportions of hip fractures. Four studies showed that stroke patients had a significantly higher risk of hip fracture compared with the general population, while the other study had a non-significant higher risk. The overall prevalence of hip fracture was 3.28 % (3431 of 104,646) in stroke patients and 2.83 % (36,493 of 1,287,726) in general population, respectively, and the unadjusted combined relative risk of hip fracture was 1.54 (95 % CI, 1.06-2.25). Hip fractures often occur in ageing and female stroke patients.

Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling

“…[10][11][12][13] Falls can result in serious consequences such as fractures, which are two times more likely in people with stroke as compared to age-matched controls. 14,15 Fractures are associated with decreased functional mobility and physical activity levels, and increased dependency in activities of daily living. 14 Other consequences of falls in post-stroke populations may include fear of falling and reduced confidence in mobility, which can have debilitating effects on the everyday life of people with stroke.…”

Cause of Death and Factors Associated With 5-Year Mortality After Hip Fracture Surgery

“…Stroke [17] was a common risk factor for hip fracture, and the incidence of hip fracture in stroke patients was 2-4 times higher than that of normal people in the same age [18] . Several previous studies [16,19] had shown that elderly hip fracture patients associated with stroke were at risk mortality, however, these reports focused mainly on early mortality.…”

Fracture risk and bone health following a stroke are inadequately considered by physicians: A UK survey of practice

“…Fracture risk increases two to four fold following a stroke [4][5][6][7][8] ; whilst 10(13.7%) physicians were aware of this, the majority 42(57.5%) underestimated fracture risk (appendix C).…”

“…Hip fractures are particularly common within the first year following stroke with a greater propensity to fracture on the paretic side and lead to poorer outcomes than in a non-stroke population [4][5][6][7][8] . Immobility, impaired nutrition and medication adherence as well as certain medications prescribed more commonly within a stroke population (e.g.…”