Abstract
Many studies have investigated the association between stroke and hip fracture risk, but the precise association was still unclear due to insufficient statistical power in single studies with relatively small sample size. Thus, we firstly conducted a meta-analysis of all published studies to precisely estimate the relationship of stroke with hip fracture risk. The strength for this relationship was weighed by pooled relative risks (RRs) with 95 % confidence intervals (95 % CIs) after adjustment for confounding variables. Stratified analyses by study design and ethnicity and sensitivity analysis were also performed. Two investigators independently performed a comprehensive literature search in databases of PubMed, Embase, and Wanfang for eligible articles. A Bayesian meta-analysis was also performed to get a more precise assessment of the relationship. Eleven relevant studies from 10 publications were finally included into our meta-analysis according to the inclusion criteria. Overall, stroke significantly and independently increased the risk of hip fracture (RR = 2.06, 95 % CI 1.68–2.52, P < 0.001). Bayesian meta-analysis showed that stroke was also associated with an over two-fold increased risk of hip fracture (RR = 2.11, 95 % CI 1.62–2.75). In stratified analysis, stroke could increase the risk of hip fracture in Caucasians (RR = 2.36, 95 % CI 1.83–3.05, P < 0.001). These data support the notion that stroke is an independent risk factor for hip fracture, and patients with stroke have a two-fold increased risk of hip fracture than those without stroke.
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Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, Chrischilles EA, Pavlik CE, Wallace RB, Ohsfeldt RL et al (2009) The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 170(10):1290–1299
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767
Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM (2006) Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma 20(3):172–178, discussion 179–180
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733
Deaton C, Froelicher ES, Wu LH, Ho C, Shishani K, Jaarsma T (2011) The global burden of cardiovascular disease. J Cardiovasc Nurs 26(4 Suppl):S5–S14
Fanapour PC, Yug B, Kochar MS (1999) Hyperhomocysteinemia: an additional cardiovascular risk factor. WMJ 98(8):51–54
Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaelsson K (2007) Cardiovascular diseases and future risk of hip fracture in women. Osteoporos Int 18(10):1355–1362
Chen JS, Hogan C, Lyubomirsky G, Sambrook PN (2011) Women with cardiovascular disease have increased risk of osteoporotic fracture. Calcif Tissue Int 88(1):9–15
Tsai CH, Lin CL, Hsu HC, Chung WS (2015) Increased risk of coronary heart disease in patients with hip fracture: a nationwide cohort study. Osteoporos Int 26(6):1849–1855
Kanis J, Oden A, Johnell O (2001) Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke 32(3):702–706
Myint PK, Poole KE, Warburton EA (2007) Hip fractures after stroke and their prevention. QJM 100(9):539–545
Kanis J, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J, Dequeker J, Dilsen G, Gennari C, Vaz AL et al (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 9(1):45–54
Lai SW, Liao KF, Lai HC, Tsai PY, Lin CL, Chen PC, Sung FC (2013) Risk of major osteoporotic fracture after cardiovascular disease: a population-based cohort study in Taiwan. J Epidemiol 23(2):109–114
Cochran WG (1950) The comparison of percentages in matched samples. Biometrika 37(3–4):256–266
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560
Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634
Stuck AE, Rubenstein LZ, Wieland D (1998) Bias in meta-analysis detected by a simple, graphical test. Asymmetry detected in funnel plot was probably due to true heterogeneity. BMJ 316(7129):469, author reply 470–461
Jackson D, Bowden J (2009) A re-evaluation of the ‘quantile approximation method’ for random effects meta-analysis. Stat Med 28(2):338–348
Sutton AJ, Abrams KR (2001) Bayesian methods in meta-analysis and evidence synthesis. Stat Methods Med Res 10(4):277–303
Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. The Northeast Hip fracture Study Group. N Engl J Med 324(19):1326–1331
Grisso JA, Kelsey JL, Strom BL, O’Brien LA, Maislin G, LaPann K, Samelson L, Hoffman S (1994) Risk factors for hip fracture in black women. The Northeast Hip fracture Study Group. N Engl J Med 330(22):1555–1559
Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302(15):1666–1673
Pouwels S, Lalmohamed A, Leufkens B, de Boer A, Cooper C, van Staa T, de Vries F (2009) Risk of hip/femur fracture after stroke: a population-based case-control study. Stroke 40(10):3281–3285
Trimpou P, Landin-Wilhelmsen K, Oden A, Rosengren A, Wilhelmsen L (2010) Male risk factors for hip fracture—a 30-year follow-up study in 7,495 men. Osteoporos Int 21(3):409–416
Wu CH, Liou TH, Hsiao PL, Lin YC, Chang KH (2011) Contribution of ischemic stroke to hip fracture risk and the influence of gender difference. Arch Phys Med Rehabil 92(12):1987–1991
Lin HL, Lin HC, Tseng YF, Liao HH, Worly JA, Pan CY, Hsu CY (2015) Hip fracture after first-ever stroke: a population-based study. Acta Neurol Scand 131(3):158–163
Benzinger P, Rapp K, Konig HH, Bleibler F, Globas C, Beyersmann J, Jaensch A, Becker C, Buchele G (2015) Risk of osteoporotic fractures following stroke in older persons. Osteoporos Int 26(4):1341–1349
Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331(7529):1374
Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E (2008) Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am 90(1):34–42
Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11(8):669–674
Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med 3:1–17
McFarlane SI (2006) Bone metabolism and the cardiometabolic syndrome: pathophysiologic insights. J Cardiometab Syndr 1(1):53–57
McFarlane SI, Muniyappa R, Shin JJ, Bahtiyar G, Sowers JR (2004) Osteoporosis and cardiovascular disease: brittle bones and boned arteries, is there a link? Endocrine 23(1):1–10
Delgado P, Cuadrado E, Rosell A, Alvarez-Sabin J, Ortega-Aznar A, Hernandez-Guillamon M, Penalba A, Molina CA, Montaner J (2008) Fas system activation in perihematomal areas after spontaneous intracerebral hemorrhage. Stroke 39(6):1730–1734
Gerischer LM, Floel A, Endres M (2015) Stroke—lifestyle and environment. Nervenarzt 86(8):947–953
Davenport RJ, Dennis MS, Wellwood I, Warlow CP (1996) Complications after acute stroke. Stroke 27(3):415–420
Jorgensen L, Jacobsen BK, Wilsgaard T, Magnus JH (2000) Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study. Osteoporos Int 11(5):381–387
Ramnemark A, Nyberg L, Lorentzon R, Olsson T, Gustafson Y (1999) Hemiosteoporosis after severe stroke, independent of changes in body composition and weight. Stroke 30(4):755–760
Wong LS, de Boer RA, Samani NJ, van Veldhuisen DJ, van der Harst P (2008) Telomere biology in heart failure. Eur J Heart Fail 10(11):1049–1056
Valdes AM, Richards JB, Gardner JP, Swaminathan R, Kimura M, Xiaobin L, Aviv A, Spector TD (2007) Telomere length in leukocytes correlates with bone mineral density and is shorter in women with osteoporosis. Osteoporos Int 18(9):1203–1210
Theill LE, Boyle WJ, Penninger JM (2002) RANK-L and RANK: T cells, bone loss, and mammalian evolution. Annu Rev Immunol 20:795–823
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This work was supported by fund for doctors from Weifang Medical University (02173401).
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L. Luan and R. Li contributed equally to this work.
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Luan, L., Li, R., Wang, Z. et al. Stroke increases the risk of hip fracture: a systematic review and meta-analysis. Osteoporos Int 27, 3149–3154 (2016). https://doi.org/10.1007/s00198-016-3632-5
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DOI: https://doi.org/10.1007/s00198-016-3632-5