Skip to main content

Advertisement

SpringerLink
Log in

Factors associated with fracture after stroke and TIA: a long-term follow-up

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We assessed the long-term incidence of fractures after stroke and TIA and analyzed associated factors. The fracture incidence increases with age and is higher in stroke than in TIA. Dementia is associated with fractures after both. Our results indicate tailored measures are necessary for preventing fractures after stroke or TIA.

Introduction

In the present study, we aimed to assess the long-term incidence of fractures and analyze associated factors after stroke or transient ischemic attack (TIA).

Methods

The current cohort study included patients who had received an initial ischemic stroke or TIA diagnosis documented anonymously in the Disease Analyzer database (IQVIA) between 2000 and 2016 by physicians in 1262 general practices in Germany. Univariate Cox and multivariate regression models were carried out.

Results

Three groups (stroke, TIA, no stroke/TIA), each with 12,265 individuals, were selected (mean age 67.3 years, 48.1% female). A fracture was diagnosed in 12.9% of stroke patients and in 11.4% of TIA patients. Among male stroke patients, 11.1% had a fracture (15.4% among female stroke patients). The hazard ratio (HR) for fractures after stroke was 1.26 (CI: 1.15–1.39) and for fractures after TIA, it was 1.14 (CI: 1.03–1.25). In female stroke patients, the HR for fractures was 1.32 (CI: 1.15–1.60), while in males, it was 1.20 (CI: 1.03–1.39). Among TIA patients, females had an elevated HR for fractures (HR: 1.21; CI: 1.06–1.37). In individuals aged ≥ 80 years, an increased risk for fractures was only detected among TIA patients (HR: 1.26; CI: 1.05–1.51). Dementia and non-opioid analgesic therapy were positively associated with fracture after both stroke and TIA.

Conclusion

Stroke was positively associated with fracture in patients < 80 years, while TIA was positively associated with fracture in patients ≥ 80 years and females. Dementia and analgesic therapy were also associated with fracture after either stroke or TIA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Carcel C, Wang X, Sandset EC, Delcourt C, Arima H, Lindley R, Hackett ML, Lavados P, Robinson TG, Muñoz Venturelli P, Olavarría VV, Brunser A, Berge E, Chalmers J, Woodward M, Anderson CS (2019) Sex differences in treatment and outcome after stroke: pooled analysis including 19,000 participants. Neurology 93:e2170–e2180

    Article  Google Scholar 

  2. Kaps M, Grittner U, Jungehulsing G, Tatlisumak T, Kessler C, Schmidt R et al (2014) Clinical signs in young patients with stroke related to FAST: results of the sifap1 study. BMJ Open 4:e005276

    Article  Google Scholar 

  3. Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, Dick F, Taylor GS, Murray G (2000) Medical complications after stroke: a multicenter study. Stroke 31:1223–1229

    Article  CAS  Google Scholar 

  4. Kumar S, Selim MH, Caplan LR (2010) Medical complications after stroke. Lancet Neurol 9:105–118

    Article  Google Scholar 

  5. Kristensen J, Birn I, Mechlenburg I (2020) Fractures after stroke-a Danish register-based study of 106 001 patients. Acta Neurol Scand 141:47–55

    Article  Google Scholar 

  6. Kapral MK, Fang J, Alibhai SM, Cram P, Cheung AM, Casaubon LK et al (2017) Risk of fractures after stroke: results from the Ontario Stroke Registry. Neurology 88:57–64

    Article  Google Scholar 

  7. Lee KB, Lee JG, Kim BJ, Kim JY, Lee KJ, Han MK, Park JM, Kang K, Cho YJ, Park HK, Hong KS, Park TH, Lee SJ, Oh MS, Yu KH, Lee BC, Cha JK, Kim DH, Kim JT, Lee J, Hong JH, Sohn SI, Kim DE, Choi JC, Yeo MJ, Kim WJ, Chae JE, Lee JS, Lee J, Bae HJ, on behalf of the CRCS-K investigators (2019) The epidemiology of fracture in patients with acute ischemic stroke in Korea. J Korean Med Sci 34:e164

    Article  Google Scholar 

  8. Yuan ZC, Mo H, Guan J, He JL, Wu ZJ (2016) Risk of hip fracture following stroke, a meta-analysis of 13 cohort studies. Osteoporos Int 27:2673–2679

    Article  CAS  Google Scholar 

  9. Foster EJ, Barlas RS, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM et al (2018) Long-term factors associated with falls and fractures poststroke. Front Neurol 9:210. https://doi.org/10.3389/fneur.2018.00210 eCollection;%2018.:210

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kim J, Cho KH, Lee SG, Lee YS, Jang SI, Park EC (2018) Differences in fracture incidence according to caregiver type in stroke survivors. J Stroke Cerebrovasc Dis 27:2849–2856

    Article  Google Scholar 

  11. Beaupre GS, Lew HL (2006) Bone-density changes after stroke. Am J Phys Med Rehabil 85:464–472

    Article  Google Scholar 

  12. Kabboord AD, van Eijk M, Fiocco M, van Balen R, Achterberg WP (2016) Assessment of comorbidity burden and its association with functional rehabilitation outcome after stroke or hip fracture: a systematic review and meta-analysis. J Am Med Dir Assoc 17:1066

    Article  Google Scholar 

  13. Kerse N, Parag V, Feigin VL, McNaughton H, Hackett ML, Bennett DA, Anderson CS (2008) Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke 39:1890–1893

    Article  Google Scholar 

  14. Rathmann W, Bongaerts B, Carius HJ, Kruppert S, Kostev K (2018) Basic characteristics and representativeness of the German Disease Analyzer database. Int J Clin Pharmacol Ther 56:459–466

    Article  Google Scholar 

  15. Ramnemark A, Nyberg L, Borsson B, Olsson T, Gustafson Y (1998) Fractures after stroke. Osteoporos Int 8:92–95

    Article  CAS  Google Scholar 

  16. Kanis J, Oden A, Johnell O (2001) Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke 32:702–706

    Article  CAS  Google Scholar 

  17. Brown DL, Morgenstern LB, Majersik JJ, Kleerekoper M, Lisabeth LD (2008) Risk of fractures after stroke. Cerebrovasc Dis 25:95–99

    Article  Google Scholar 

  18. Nozoe M, Kanai M, Kubo H, Yamamoto M, Shimada S, Mase K (2019) Prestroke sarcopenia and stroke severity in elderly patients with acute stroke. J Stroke Cerebrovasc Dis 28:2228–2231

    Article  Google Scholar 

  19. Goto Y, Otaka Y, Suzuki K, Inoue S, Kondo K, Shimizu E (2019) Incidence and circumstances of falls among community-dwelling ambulatory stroke survivors: a prospective study. Geriatr Gerontol Int 19:240–244

    Article  Google Scholar 

  20. Wei WE, De Silva DA, Chang HM, Yao J, Matchar DB, Young SHY et al (2019) Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study. BMC Geriatr 19:1373–1377

    Google Scholar 

  21. Avin KG, Hanke TA, Kirk-Sanchez N, McDonough CM, Shubert TE, Hardage J, Hartley G (2015) Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Phys Ther 95:815–834

    Article  Google Scholar 

  22. Lackoff AS, Hickling D, Collins PF, Stevenson KJ, Nowicki TA, Bell JJ (2020) The association of malnutrition with falls and harm from falls in hospital inpatients: findings from a 5-year observational study. J Clin Nurs 29:429–436

    Article  Google Scholar 

  23. Correa-Perez A, Delgado-Silveira E, Martin-Aragon S, Cruz-Jentoft AJ (2019) Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol. Ther Adv Drug Saf 10:2042098619868640. https://doi.org/10.1177/2042098619868640 eCollection;%2019

    Article  PubMed  PubMed Central  Google Scholar 

  24. Scrutinio D, Lanzillo B, Guida P, Passantino A, Spaccavento S, Battista P (2019) Association between malnutrition and outcomes in patients with severe ischemic stroke undergoing rehabilitation. Arch Phys Med Rehabil 101:852–860

    Article  Google Scholar 

  25. Scherbakov N, von Haehling S, Anker SD, Dirnagl U, Doehner W (2013) Stroke induced Sarcopenia: muscle wasting and disability after stroke. Int J Cardiol 170:89–94

    Article  Google Scholar 

  26. Schnitzer S, Deutschbein J, Nolte CH, Kohler M, Kuhlmey A, Schenk L (2017) How does sex affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund. Top Stroke Rehabil 24:415–421

    Article  Google Scholar 

  27. Batchelor F, Hill K, Mackintosh S, Said C (2010) What works in falls prevention after stroke?: a systematic review and meta-analysis. Stroke 41:1715–1722

    Article  Google Scholar 

  28. Lach HW, Harrison BE, Phongphanngam S (2017) Falls and fall prevention in older adults with early-stage dementia: an integrative review. Res Gerontol Nurs 10:139–148

    Article  Google Scholar 

  29. Petersen JD, Siersma VD, Christensen RD, Storsveen MM, Nielsen CT, Waldorff FB (2018) The risk of fall accidents for home dwellers with dementia-a register-and population-based case-control study. Alzheimers Dement (Amst) 10:421–428. https://doi.org/10.1016/j.dadm.2018.05.004 eCollection;%2018

    Article  Google Scholar 

  30. Ballard C, Rowan E, Stephens S, Kalaria R, Kenny RA (2003) Prospective follow-up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke 34:2440–2444

    Article  Google Scholar 

  31. Vestergaard P (2008) Pain-relief medication and risk of fractures. Curr Drug Saf 3:199–203

    Article  CAS  Google Scholar 

  32. Chuang PY, Shen SH, Yang TY, Huang TW, Huang KC (2016) Non-steroidal anti-inflammatory drugs and the risk of a second hip fracture: a propensity-score matching study. BMC Musculoskelet Disord 17:201–1047. https://doi.org/10.1186/s12891-016-1047-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Donath L, van Dieen J, Faude O (2016) Exercise-based fall prevention in the elderly: what about agility? Sports Med 46:143–149

    Article  Google Scholar 

  34. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community Cochrane Database Syst Rev CD007146

  35. Tsuda T (2017) Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Curr Orthop Pract 28:580–585

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, Wichernstrasse 40, 57074, Siegen, Germany

    C. Tanislav

  2. Epidemiology, IQVIA, Frankfurt am Main, Germany

    K. Kostev

Authors
  1. C. Tanislav
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Kostev
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Tanislav.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanislav, C., Kostev, K. Factors associated with fracture after stroke and TIA: a long-term follow-up. Osteoporos Int 31, 2395–2402 (2020). https://doi.org/10.1007/s00198-020-05535-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05535-5

Keywords

Search

Navigation