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Risk of osteoporotic fractures following stroke in older persons

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Abstract

Summary

The aim of this study was to explore the increased risk of stroke survivors to different sustained osteoporotic fractures. We used hospital data and data on functional impairment. We found a higher risk in stroke survivors without functional impairment with the risk higher for lower than for upper extremity fractures.

Introduction

Stroke survivors are at high risk of osteoporotic fractures due to frequent falls and an increased risk to develop osteoporosis. Data on their relative risk to sustain other than hip fractures is limited. Furthermore, the role of severe functional impairment on their fracture risk has not been considered yet. The aim of this study was to determine the relative risk of stroke survivors to sustain different osteoporotic fractures with regard to the presence of severe functional impairment.

Methods

Data from 2004 to 2009 of more than 1.2 million individuals aged 65 years or older and insured at a large German health insurance company were used for the analyses. Incident stroke and fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment. Persons without preceding incident stroke were used as the reference group. Multistate models were used to estimate hazard ratios.

Results

Stroke survivors had a higher risk for fractures. However, a strong effect modification by functional impairment was apparent. Stroke survivors with functional impairment had no significantly increased risk for any fractures site compared to the corresponding reference group with functional impairment. In contrast, stroke survivors without functional impairment had a clearly and significantly increased fracture risk for most fracture sites. In these persons, the relative fracture risk for fractures of the lower extremities was higher than for fractures of the upper extremities.

Conclusion

To evaluate the relative risk of stroke survivors for osteoporotic fractures, functional status appears to be a relevant parameter.

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Statement of human rights

Anonymised data were obtained by the insurance company. The insurants were not contacted personally for informed consent. The study was approved by the Ethical Committee of Ulm University.

Funding

The analysis was supported by the “Bundesministerium für Bildung und Forschung” (01EC1007A).

Conflicts of interest

Petra Benzinger, Kilian Rapp, Hans-Helmut König, Florian Bleibler, Christoph Globas, Jan Beyersmann, Andrea Jaensch, Clemens Becker, and Gisela Büchele declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany

    P. Benzinger & K. Rapp

  2. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholzstraße 22, 89081, Ulm, Germany

    K. Rapp

  3. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    H. H. König & F. Bleibler

  4. Clinic of Neurology, University Hospital Zurich, Frauenklinikstr. 26, CH-8091, Zurich, Switzerland

    C. Globas, A. Jaensch & G. Büchele

  5. Institute of Statistics, Ulm University, Helmholtzstraße 18, 89081, Ulm, Germany

    J. Beyersmann & C. Becker

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  1. P. Benzinger
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  2. K. Rapp
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Correspondence to P. Benzinger.

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Benzinger, P., Rapp, K., König, H.H. et al. Risk of osteoporotic fractures following stroke in older persons. Osteoporos Int 26, 1341–1349 (2015). https://doi.org/10.1007/s00198-014-3005-x

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  • DOI: https://doi.org/10.1007/s00198-014-3005-x

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