title: Poststroke fractures in a bi-ethnic community.
abstract: BACKGROUND
  Mexican Americans have increased risks of stroke and lower fractures compared with non-Hispanic whites, but little is known about poststroke fracture risk in Mexican Americans. The objective of this study was to describe poststroke fracture risk in a bi-ethnic population and to compare risk by ethnicity.
  
  
  METHODS
  In the Brain Attack Surveillance in Corpus Christi Project, strokes were identified through hospital surveillance (2000-2004) and validated by neurologists (n = 2389). Inpatient claims for fractures were ascertained (2000-2004) and cross-referenced with strokes. Survival free from fracture (any and hip) poststroke was estimated and compared by ethnicity. Cox regression was used to test the association of ethnicity and fracture risk adjusted for confounders. Interaction terms for ethnicity and age were considered.
  
  
  RESULTS
  The mean age was 71 years (SD, 13 yrs); 54% were Mexican American and 52% were women. The mean follow-up was 4 years. There were 105 fractures (33% of the hips). Survival free of any fracture and of hip fracture did not differ by ethnicity. Increasing age, female gender, intracerebral hemorrhage, and greater stroke severity were associated with risk of any fracture, but ethnicity was not. Ethnicity was associated with risk of hip fracture, but this association was modified by age (P = .02), where Mexican Americans were protected from hip fractures at younger but not older ages.
  
  
  CONCLUSIONS
  Stroke patients were at high risk for fractures, with a 10% risk at 5 years. Mexican Americans were protected from hip fractures at younger but not older ages. Both elderly Mexican Americans and non-Hispanic whites should be targeted for poststroke fracture prevention.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan 48109, USA. llisabet@umich.edu
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sanchez
authors.forename: Darin B
authors.initials: DB
authors.lastname: Zahuranec
authors.forename: Lesli E
authors.initials: LE
authors.lastname: Skolarus
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.forename: Michael
authors.initials: M
authors.lastname: Kleerekoper
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Smith
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000517:prevention & control; D006620:Hip Fractures / Q000208:ethnology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data*