Click
here to close Hello! We notice that
you are using Internet Explorer, which is not supported by Echinobase
and may cause the site to display incorrectly. We suggest using a
current version of Chrome,
FireFox,
or Safari.
Neurology
2017 Jan 03;881:57-64. doi: 10.1212/WNL.0000000000003457.
Show Gene links
Show Anatomy links
Risk of fractures after stroke: Results from the Ontario Stroke Registry.
Kapral MK
,
Fang J
,
Alibhai SM
,
Cram P
,
Cheung AM
,
Casaubon LK
,
Prager M
,
Stamplecoski M
,
Rashkovan B
,
Austin PC
.
???displayArticle.abstract???
OBJECTIVE: To determine the risk of fractures after stroke.
METHODS: Using the Ontario Stroke Registry, we identified a population-based sample of consecutive patients seen in the emergency department or hospitalized with stroke (n = 23,751) or TIA (n = 11,240) at any of 11 stroke centers in Ontario, Canada, and discharged alive between July 1, 2003, and March 31, 2012. We compared the risk of low-trauma fractures in patients with stroke vs those with TIA using propensity score methods to adjust for differences in baseline factors. Secondary analyses compared fracture risk poststroke with that in age-/sex-matched controls without stroke or TIA (n = 23,751) identified from the Ontario Registered Persons Database.
RESULTS: The 2-year rate of fracture was 5.7% in those with stroke compared to 4.8% in those with TIA (adjusted cause-specific hazard ratio [aHR] for those with stroke vs TIA 1.32; 95% confidence interval [CI] 1.19-1.46) and 4.1% in age-/sex-matched controls (aHR for those with stroke vs controls 1.47; 95% CI 1.35-1.60). In the cohort with stroke, factors associated with fractures were older age, female sex, moderate stroke severity, prior fractures or falls, and preexisting osteoporosis, rheumatoid arthritis, hyperparathyroidism, and atrial fibrillation.
CONCLUSIONS: Stroke is associated with an increased risk of low-trauma fractures. Individuals with stroke and additional risk factors for fractures may benefit from targeted screening for low bone mineral density and initiation of treatment for fracture prevention.
Austin,
The performance of different propensity score methods for estimating marginal hazard ratios.
2013, Pubmed
Austin,
The performance of different propensity score methods for estimating marginal hazard ratios.
2013,
Pubmed
Austin,
Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.
2015,
Pubmed
Austin,
An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies.
2011,
Pubmed
Batchelor,
What works in falls prevention after stroke?: a systematic review and meta-analysis.
2010,
Pubmed
Beaupre,
Bone-density changes after stroke.
2006,
Pubmed
Brown,
Risk of fractures after stroke.
2008,
Pubmed
Callaly,
Falls and fractures 2 years after acute stroke: the North Dublin Population Stroke Study.
2015,
Pubmed
Carda,
Osteoporosis after stroke: a review of the causes and potential treatments.
2009,
Pubmed
Cosman,
Clinician's Guide to Prevention and Treatment of Osteoporosis.
2014,
Pubmed
Czernuszenko,
Risk factors for falls in stroke patients during inpatient rehabilitation.
2009,
Pubmed
Côté,
The Canadian Neurological Scale: validation and reliability assessment.
1989,
Pubmed
Dennis,
Fractures after stroke: frequency, types, and associations.
2002,
Pubmed
Feigin,
Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study.
2015,
Pubmed
Forster,
Incidence and consequences of falls due to stroke: a systematic inquiry.
1995,
Pubmed
Ioannidis,
Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study.
2009,
Pubmed
Jørgensen,
Functional status of the paretic arm affects the loss of bone mineral in the proximal humerus after stroke: a 1-year prospective study.
2001,
Pubmed
Kanis,
Interpretation and use of FRAX in clinical practice.
2011,
Pubmed
Kanis,
Acute and long-term increase in fracture risk after hospitalization for stroke.
2001,
Pubmed
Kapral,
Effect of a provincial system of stroke care delivery on stroke care and outcomes.
2013,
Pubmed
,
Echinobase
Keene,
Mortality and morbidity after hip fractures.
1993,
Pubmed
Lazoura,
Bone mineral density alterations in upper and lower extremities 12 months after stroke measured by peripheral quantitative computed tomography and DXA.
2008,
Pubmed
Lisabeth,
Poststroke fractures in a bi-ethnic community.
2012,
Pubmed
Marsden,
Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence.
2008,
Pubmed
Myint,
Hip fractures after stroke and their prevention.
2007,
Pubmed
Pang,
The effects of treadmill exercise training on hip bone density and tibial bone geometry in stroke survivors: a pilot study.
2010,
Pubmed
Pang,
Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: implications for stroke rehabilitation.
2005,
Pubmed
Pang,
Muscle weakness, spasticity and disuse contribute to demineralization and geometric changes in the radius following chronic stroke.
2007,
Pubmed
Papaioannou,
2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary.
2010,
Pubmed
Papaioannou,
The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study.
2009,
Pubmed
Pouwels,
Risk of hip/femur fracture after stroke: a population-based case-control study.
2009,
Pubmed
Ramnemark,
Progressive hemiosteoporosis on the paretic side and increased bone mineral density in the nonparetic arm the first year after severe stroke.
1999,
Pubmed
Ramnemark,
Stroke, a major and increasing risk factor for femoral neck fracture.
2000,
Pubmed
Ramnemark,
Fractures after stroke.
1998,
Pubmed
Sato,
Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke.
2005,
Pubmed
Sato,
Risedronate therapy for prevention of hip fracture after stroke in elderly women.
2005,
Pubmed
Schnitzer,
Bone mineral density in patients with stroke: relationship with motor impairment and functional mobility.
2012,
Pubmed