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

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Abstract

Summary

Our study indicates that hip fracture is independently associated with increased risk of developing stroke. In addition, the risk of stroke following the incidence of hip fracture is more prominent in younger patients, men, those with cardiovascular comorbidities, and in patients using specific medication, such as diuretics and ABRs.

Introduction

Hip fractures are associated with increased risk of major morbidity. However, few data are available on the risk of stroke after hip fracture. Therefore, we investigated whether hip fracture increases the risk of stroke in a large nationwide cohort study.

Methods

Using universal insurance claims data, we identified a study cohort comprising of 6013 newly diagnosed with hip fracture patients from 2000 to 2010 and a non-hip fracture cohort of 23,802 participants. Incidence and risk of stroke were estimated for both cohorts until the end of 2011.

Results

Stroke incidence was 1.69-fold (95 % confidence interval [CI] = 1.56–1.83) higher in the hip fracture cohort than in the comparison cohort with an adjusted hazard ratio (HR) of 1.54 (95 % CI = 1.42–1.67) for the hip fracture cohort. The hip fracture patients were at higher risk of developing ischemic stroke (HR = 1.55, 95 % CI = 1.42–1.69) and hemorrhagic stroke (HR = 1.55, 95 % CI = 1.16–1.89), respectively. At an incidence of 64.6 per 1000 person-years, the adjusted HR of stroke increases to 3.10 (95 % CI = 2.47–3.90) for patients with coexisting diabetes, hypertension, and heart failure compared with those without these three conditions. At an incidence of 60.4 per 1000 person-years, the adjusted HR of stroke increases to 2.92 (95 % CI = 2.43–3.51) for hip fracture patients prescribed with diuretics and angiotensin II receptor blockers (ARBs) compared with those without hip fracture or prescriptions for diuretics or ARBs.

Conclusions

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

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Acknowledgments

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW103-TDU-B-212-113002), China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM103010096), NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039-006-), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan

    C.-H. Tsai & H.-C. Hsu

  2. Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan

    C.-H. Tsai & H.-C. Hsu

  3. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    C.-L. Lin

  4. Department of Public health, China Medical University, Taichung, Taiwan

    C.-L. Lin

  5. Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, San-Min Road, Taichung City, 40343, Taiwan

    W.-S. Chung

  6. Department of Health Services Administration, China Medical University, Taichung, Taiwan

    W.-S. Chung

Authors
  1. C.-H. Tsai
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  2. C.-L. Lin
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  3. H.-C. Hsu
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  4. W.-S. Chung
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Corresponding author

Correspondence to W.-S. Chung.

Additional information

All authors have contributed significantly, and that all authors are in agreement with the content of the manuscript: Conception/Design: Wei-Sheng Chung, Chun-Hao Tsai; Collection and/or assembly of data: All authors; Data analysis and interpretation: Wei-Sheng Chung, Chun-Hao Tsai, Cheng-Li Lin; Manuscript writing: All authors; Final approval of manuscript: All authors

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Tsai, CH., Lin, CL., Hsu, HC. et al. Increased risk of stroke among hip fracture patients: a nationwide cohort study. Osteoporos Int 26, 645–652 (2015). https://doi.org/10.1007/s00198-014-2919-7

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  • DOI: https://doi.org/10.1007/s00198-014-2919-7

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