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Fractures after stroke
A Ramnemark1, L Nyberg, B Borssén
1Department of Geriatric Medicine, Umeå University, Sweden. anna.ramnemark@germed.umu.se
Insights
Fractures are a common complication after stroke, particularly hip fractures. Prevention strategies should address fall risks and osteoporosis in stroke survivors.
Area of Science:
- Neurology
- Orthopedics
- Epidemiology
Background:
- Fractures represent a significant complication for stroke survivors.
- A substantial proportion of patients with femoral neck fractures have a history of stroke.
Purpose of the Study:
- To determine the incidence of fractures following acute stroke.
- To compare hip fracture rates in stroke patients with the general population.
Main Methods:
- Retrospective analysis of 1139 patients admitted for acute stroke.
- Fracture data collected from stroke onset to study end or death.
- Follow-up duration of 4132 patient-years (median 2.9 years).
Main Results:
- 154 fractures occurred in 120 patients, with a median time of 24 months from stroke onset to first fracture.
- Women experienced significantly more fractures than men (p < 0.001).
- Fractures predominantly affected the paretic side in patients with paresis (p < 0.001) and 84% resulted from falls.
- Hip fractures were most common, with an incidence 2-4 times higher than in the general population.
Conclusions:
- Fractures are a frequent complication post-stroke, often caused by falls and affecting the paretic limb.
- Increased incidence of hip fractures highlights the vulnerability of stroke patients.
- Emphasizes the need for targeted prevention of post-stroke fractures, addressing falls and osteoporosis.
Abstract:
Fractures are a serious complication after stroke. Among patients with femoral neck fractures, a large subgroup have had a previous stroke. This study aimed to investigate the incidence of fractures after stroke. Included in the study were 1139 patients consecutively admitted for acute stroke. Fractures occurring from stroke onset until the end of the study or death were registered retrospectively. Hip fracture incidence was compared with corresponding rates from the general population. Patients were followed up for a total of 4132 patient-years (median 2.9 years). There were 154 fractures in 120 patients and median time between the onset of stroke and the first fracture was 24 months. Women had significantly more fractures than men (chi 2 = 15.6; p < 0.001). In patients with paresis most of the fractures affected the paretic side (chi 2 = 22.5; p < 0.001) and 84% of the fractures were caused by falls. Hip fracture was the most frequent fracture and the incidence was 2-4 times higher in stroke patients compared with the reference population. Fractures are thus a common complication after stroke. They are usually caused by falls and affect the paretic side. It is necessary to focus on the prevention of post-stroke fractures, including the prevention of both falls and osteoporosis.