The interplay between stroke and hip fractures: a narrative review of mechanisms, risk assessment, and prevention

Stroke survivors face a substantially increased risk of hip fractures due to a combination of motor impairments, falls, and stroke-induced bone density loss. Conversely, hip fractures in this population are associated with elevated mortality, reduced functional recovery, and greater healthcare burden. This narrative review synthesizes current evidence on the epidemiological, pathophysiological, and clinical interrelationships between stroke and hip fractures. Key quantitative findings include a 7.6% incidence of hip fractures within 5 years post-stroke-significantly higher than the 2.8% observed in non-stroke populations-and a 30-day postoperative mortality rate of up to 14.8% in stroke patients with hip fractures. Severe post-stroke disability is associated with a 2.1- to 4.8-fold increased risk of hip fracture compared to those with good recovery. The review also highlights the utility of risk assessment tools such as FRAX and emerging prediction models, and evaluates prevention strategies including osteoporosis screening, exercise-based rehabilitation, and lifestyle modifications.