title: Adding injury to insult: fracture risk after stroke in veterans.
abstract: OBJECTIVE
  To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts.
  
  
  METHODS
  Secondary analyses of two prospective cohorts.
  
  
  METHODS
  Veterans Affairs (VA) Medical Centers.
  
  
  METHODS
  The VA Acute Stroke (VASt) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997. The Integrated Stroke Outcomes Database (ISOD) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002.
  
  
  METHODS
  Fractures detected using International Classification of Diseases, 9th Revision, codes in the VA computerized patient record system; baseline patient characteristics and stroke features; Functional Independence Measures scores in ISOD.
  
  
  RESULTS
  Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1% and 4.7%, respectively. Longer hospitalizations for stroke (P=.06) and new motor or sensory impairment (P=.09) showed trends toward greater risk in the VASt cohort. Female sex (P <.001), cognitive impairment (P=.01), and nonblack race (P=.04) were associated with higher fracture risk in the ISOD. Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment.
  
  
  CONCLUSIONS
  Veterans who suffer a stroke are at high risk of subsequent fracture, which can lead to further disability. Women, nonblacks, and those with intermediate functional impairment were at particularly high risk of fracture. Future study should investigate therapies to decrease fracture risk in stroke patients.
authors.affiliation: Center for the Study of Aging, Duke University Medical Center, Durham, North Carolina 27710, USA. heather.whitson@duke.edu
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Linda
authors.initials: L
authors.lastname: Sanders
authors.forename: Ronnie D
authors.initials: RD
authors.lastname: Horner
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Lyles
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States; D014728:Veterans