Stroke and osteoporosis: a Taiwan cohort study

Zhang, Li; Zhang, Zi-Hao; Su, Ying-Ju; Lu, Ying‐Yi; Zhang, Cong-Liang; Tsai, Hung-Pei; Wu, Chieh‐Hsin

doi:10.1136/postgradmedj-2019-136959

Cited by 16 publications

(7 citation statements)

References 32 publications

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“…Third, according to recent researches [39], cerebrovascular disease generally considered to be associated with osteoporosis. Zhang et al [40] investigated database for Taiwan population, they concluded that the population of patients with stroke revealed a higher osteoporosis risk, and poststroke osteoporosis was signi cant in male gender, which is also consistent to our study. Previous study [41] used osteoporosis related factors to predict risk of fracture in Chinese male population.…”

Section: Discussionsupporting

confidence: 92%

Development and Validation of a Novel Nomogram Based on Systemic Immune-Inflammation Index for Predicting the Risk of Osteoporosis in Chinese Male Population

Zhuo,

Zhou,

Chen

et al. 2024

Preprint

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Summary Based on SII and PLR, markers of inflammation detected by routine blood tests, we developed a multivariate logistic regression analysis prediction model that showed good correct discriminant (C-index = 0.822) and good calibration for effective diagnosis of osteoporosis in the male population. Introduction Osteoporosis (OP) is a bone metabolism disease that is associated with inflammatory pathological mechanism. Nonetheless, rare studies have investigated the diagnostic effectiveness of immune-inflammation index in the male population. Therefore, it is interesting to achieve early diagnosis of OP in male population based on the inflammatory makers from blood routine examination. Methods We developed a prediction model based on a training dataset of 826 Chinese male patients, and the data was collected from January 2021 to May 2022. All participants underwent the dual-energy X-ray absorptiometry (DXEA) and blood routine examination. Inflammatory markers such as systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) was calculated and recorded. We utilized the least absolute shrinkage and selection operator (LASSO) regression model to optimize feature selection. Multivariable logistic regression analysis was applied to construct a predicting model incorporating the feature selected in the LASSO model. This predictive model was displayed as a nomogram. Receiver operating characteristic (ROC) curve, C-index, calibration curve, and clinical decision curve analysis (DCA) to evaluate model performance. Internal validation was test by the bootstrapping method. This study was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Ethic No. JY2023012) and conducted in accordance with the relevant guidelines and regulations. Results The predictive factors included in the prediction model were age, BMI, cardiovascular diseases, cerebrovascular diseases, neuropathy, thyroid diseases, fracture history, SII, PLR, C-reactive protein (CRP). The model displayed well discrimination with a C-index of 0.822 (95% confidence interval: 0.798-0.846) and good calibration. Internal validation showed a high C-index value of 0.805. Decision curve analysis (DCA) showed that when the threshold probability was between 3% and 76%, the nomogram had a good clinical value. Conclusion This nomogram can effectively predict the incidence of OP in male population based on SII and PLR, which would help clinicians rapidly and conveniently diagnose OP with men in the future.

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Section: Discussionsupporting

confidence: 92%

Development and Validation of a Novel Nomogram Based on Systemic Immune-Inflammation Index for Predicting the Risk of Osteoporosis in Chinese Male Population

Zhuo,

Zhou,

Chen

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…On the other hand, even though stroke is a well-known risk factor for developing osteoporosis ( 31 , 32 ), the utilization rates of BMD testing and osteoporosis treatment were quite low after stroke. The likelihood of using these two measures was even lower in patients with greater stroke severity.…”

Section: Discussionmentioning

confidence: 99%

“…This study further demonstrated that stroke patients carried a significantly higher risk of low-trauma fracture within one year than non-stroke patients (1.7% vs. 0.6%, p <0.001). In particular, stroke may contribute more to the risk of subsequent osteoporosis in the male sex and younger age ( 31 ). A decline in cognitive function and a high comorbidity burden such as dementia also increase the risk of osteoporotic fractures among stroke survivors ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Utilization of screening and treatment for osteoporosis among stroke survivors

Hsu

Sung²,

Yang³

et al. 2022

Front. Endocrinol.

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BackgroundStroke survivors are prone to osteoporosis and fractures. However, bone mineral density (BMD) testing and osteoporosis treatment were underutilized in patients with recent stroke. We aimed to examine whether stroke has an impact on the utilization of BMD testing and osteoporosis treatment as well as the determinants of their utilization in stroke patients using nationwide population-based data in Taiwan.MethodsWe identified patients aged 55 years and older who were hospitalized for hemorrhagic or ischemic stroke as the stroke cohort, and age- and sex-matched patients hospitalized for reasons other than stroke, fracture, or fall as the non-stroke cohort. We used the Fine-Gray sub-distribution hazard competing risk regression model to determine the predictors for BMD testing and osteoporosis treatment.ResultsA total of 32997 stroke patients and 32997 age- and sex-matched controls comprised the stroke and non-stroke cohorts, respectively. BMD testing and osteoporosis treatment were performed in 1.0% and 5.2% of the stroke patients, respectively, within one year after hospitalization while these measures were performed in 0.8% and 4.7% of the controls. Stroke patients were more likely to receive BMD testing (adjusted hazard ratio [HR] 1.33; 95% confidence interval [CI] 1.11–1.58) and osteoporosis treatment (adjusted HR 1.19; 95% CI 1.11–1.29). Female sex, osteoporosis, prior BMD testing, and low-trauma fractures after stroke increased the likelihood of using BMD testing and osteoporosis treatment whereas greater stroke severity reduced the likelihood of receiving both measures.ConclusionsBoth BMD testing and osteoporosis treatment were underutilized among stroke survivors even though they had a higher chance of receiving both measures than non-stroke patients.

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“…The age, gender and average insured payroll of the LHID2010 and NHIRD are not significantly different. The LHID2010 has been used for stroke-related studies 20–23…”

Section: Methodsmentioning

confidence: 99%

Ten-year follow-up investigation of stroke risk in systemic lupus erythematosus

Huang

Lin

et al. 2023

Stroke Vasc Neurol

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Background and purposeTo analyse the long-term risk of ischaemic stroke and the clinical effects of antithrombotics on the risk of haemorrhagic stroke in patients with systemic lupus erythematosus (SLE).MethodsA retrospective cohort study was conducted using a population-based database taken from Taiwan National Health Insurance Research Database. Patients with SLE between 2000 and 2008 were registered and matched with two controls by the index date, age, gender and Charlson Comorbidity Index (CCI). These subjects were followed until either stroke event or 31 December 2013. Adjusted HRs (aHRs) for strokes were estimated with Cox regression models, and the cumulative incidence of ischaemic stroke was analysed by log-rank test and Kaplan-Meier survival analysis.ResultsIn total, 8310 patients with SLE and 16 620 patients without SLE were included. In general, patients with SLE had higher rates of ischaemic stroke (5.4% vs 3.3%) and haemorrhagic stroke (1.5% vs 0.6%) than in controls. In multivariate analysis adjusted to age, gender, CCI, urbanisation level and antithrombotics uses, aHRs of all strokes, ischaemic stroke and haemorrhagic stroke were 1.73 (95% CI: 1.54 to 1.94), 1.65 (95% CI: 1.45 to 1.87) and 2.24 (95% CI: 1.71 to 2.95), respectively, in patients with SLE. Patients with SLE were significantly more likely to suffer ischaemic stroke than patients without SLE, even 10 years after SLE diagnosis (6.12% vs 3.50%, p<0.001). Antiplatelet use increased the risk of haemorrhagic stroke in SLE group (aHR=1.74, 95% CI: 1.18 to 2.57).ConclusionsPatients with SLE are at greater risk of developing ischaemic stroke that lasts for 10 years. Antiplatelets should be carefully administered to prevent cardiovascular events in patients with SLE due to the risk of haemorrhagic stroke.

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Stroke and osteoporosis: a Taiwan cohort study

Cited by 16 publications

References 32 publications

Development and Validation of a Novel Nomogram Based on Systemic Immune-Inflammation Index for Predicting the Risk of Osteoporosis in Chinese Male Population

Development and Validation of a Novel Nomogram Based on Systemic Immune-Inflammation Index for Predicting the Risk of Osteoporosis in Chinese Male Population

Utilization of screening and treatment for osteoporosis among stroke survivors

Ten-year follow-up investigation of stroke risk in systemic lupus erythematosus

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