Risk of hip/femur fracture after stroke: a population-based case-control study.
OBJECTIVE
Stroke increases the risk of hip/femur fracture, as seen in several studies, although the time course of this increased risk remains unclear. Therefore, our purpose is to evaluate this risk and investigate the time course of any elevated risk.


METHODS
We conducted a case-control study using the Dutch PHARMO Record Linkage System database. Cases (n=6763) were patients with a first hip/femur fracture; controls were matched by age, sex, and region. Odds ratio (OR) for the risk of hip/femur fracture was derived using conditional logistic regression analysis, adjusted for disease and drug history.


RESULTS
An increased risk of hip/femur fracture was observed in patients who experienced a stroke at any time before the index date (adjusted OR, 1.96; 95% CI, 1.65-2.33). The fracture risk was highest among patients who sustained a stroke within 3 months before the index date (adjusted OR, 3.35; 95% CI, 1.87-5.97) and among female patients (adjusted OR, 2.12; 95% CI, 1.73-2.59). The risk further increased among patients younger than 71 years (adjusted OR, 5.12; 95% CI, 3.00-8.75). Patients who had experienced a hemorrhagic stroke tended to be at a higher hip/femur fracture risk compared with those who had experienced an ischemic stroke.


CONCLUSIONS
Stroke is associated with a 2.0-fold increase in the risk of hip/femur fracture. The risk was highest among patients younger than 71 years, females, and those whose stroke was more recent. Fall prevention programs, bone mineral density measurements, and use of bisphosphonates may be necessary to reduce the occurrence of hip/femur fractures during and after stroke rehabilitation.
Pouwels
Sander
S
Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Pharmacotherapy, University Utrecht, Utrecht, The Netherlands.
Lalmohamed
Arief
A
Leufkens
Bert
B
de Boer
Anthonius
A
Cooper
Cyrus
C
van Staa
Tjeerd
T
de Vries
Frank
F
D000058:Accidental Falls / Q000401:mortality; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000453:epidemiology; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates