Skip to main content
Erschienen in: Archives of Osteoporosis 1/2017

01.12.2017 | Original Article

Association of stroke subtypes with risk of hip fracture: a population-based study in Taiwan

verfasst von: Jing-Quan Zheng, Hui-Ju Lai, Cai-Mei Zheng, Yu-Chun Yen, Kuo-Cheng Lu, Chaur-Jong Hu, Hsun-Hua Lee, Yuan-Hung Wang

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Summary

Stroke is a critical issue of physical disability. This study aimed to investigate the association of stroke subtypes and hip fracture by using the Taiwan National Health Insurance Research Database. Significantly higher risks of hip fracture were found for female gender and intracerebral hemorrhagic stroke patients.

Introduction

Previous studies reported the increased hip fracture (HF) after acute stroke. Increased falling tendency immobilization-related sarcopenia and underlying comorbidities are related to HF in stroke patients. In the present study, we explored the association of different stroke subtypes and several comorbidities with poststroke HF.

Methods

A population-based study was conducted using National Health Insurance Research Database (NHIRD) of Taiwan. First, we identified 17,168 patients diagnosed as having a stroke between January 1, 2002, and December 31, 2010. Then, we randomly selected 51,504 controls that never had a stroke and matched these controls to stroke patients in a 1:3 ratio by age (± 1 year old) and gender. Cox proportional hazards model was used to estimate hazard ratio (HR) and 95% confidence interval (CI).

Results

Stroke patients had a significantly higher risk of HF (HR = 1.69). Female and male stroke patients had incidence rate ratios (IRRs) of 2.05 and 1.82 for HF, respectively. Significantly increased IRRs of 1.82, 1.52, and 2.63 for HF were found for stroke patients with 0, 1, and ≥ 2 comorbidities, respectively. All stroke patients, ischemic stroke patients, and intracerebral hemorrhagic (ICH) patients had HF risks of 1.65, 1.60, and 2.34, respectively.

Conclusion

Overall, stroke significantly increases the incidence of HF, and the risk of HF is significantly higher in ICH patients and female gender. We should identify stroke patients at risk of HF and pay more attention to prevent them from fall in poststroke long-term care.
Literatur
1.
Zurück zum Zitat Lloyd-Jones D, Adams R, Carnethon M et al (2009) Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119:480–486CrossRefPubMed Lloyd-Jones D, Adams R, Carnethon M et al (2009) Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119:480–486CrossRefPubMed
2.
Zurück zum Zitat Chen CY, Huang YB, Tzu-Chi Lee C (2013) Epidemiology and disease burden of ischemic stroke in Taiwan. Int J Neurosci 123:724–731CrossRefPubMed Chen CY, Huang YB, Tzu-Chi Lee C (2013) Epidemiology and disease burden of ischemic stroke in Taiwan. Int J Neurosci 123:724–731CrossRefPubMed
3.
Zurück zum Zitat Lai EC, Man KK, Chaiyakunapruk N et al (2015) Brief report: databases in the Asia-Pacific Region: the potential for a distributed network approach. Epidemiology 26:815–820CrossRefPubMed Lai EC, Man KK, Chaiyakunapruk N et al (2015) Brief report: databases in the Asia-Pacific Region: the potential for a distributed network approach. Epidemiology 26:815–820CrossRefPubMed
4.
Zurück zum Zitat Nyberg L, Gustafson Y (1995) Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke 26:838–842CrossRefPubMed Nyberg L, Gustafson Y (1995) Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke 26:838–842CrossRefPubMed
5.
Zurück zum Zitat Goodman CR (1971) Osteoporosis as early complication of hemiplegia. N Y State J Med 71:1943–1945PubMed Goodman CR (1971) Osteoporosis as early complication of hemiplegia. N Y State J Med 71:1943–1945PubMed
6.
Zurück zum Zitat Liu M, Tsuji T, Higuchi Y, Domen K, Tsujiuchi K, Chino N (1999) Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry. Arch Phys Med Rehabil 80:1219–1226CrossRefPubMed Liu M, Tsuji T, Higuchi Y, Domen K, Tsujiuchi K, Chino N (1999) Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry. Arch Phys Med Rehabil 80:1219–1226CrossRefPubMed
8.
Zurück zum Zitat Sato Y (2000) Abnormal bone and calcium metabolism in patients after stroke. Arch Phys Med Rehabil 81:117–121CrossRefPubMed Sato Y (2000) Abnormal bone and calcium metabolism in patients after stroke. Arch Phys Med Rehabil 81:117–121CrossRefPubMed
9.
Zurück zum Zitat Ramnemark A, Nilsson M, Borssen B, Gustafson Y (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577CrossRefPubMed Ramnemark A, Nilsson M, Borssen B, Gustafson Y (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577CrossRefPubMed
10.
Zurück zum Zitat Dennis MS, Lo KM, McDowall M, West T (2002) Fractures after stroke: frequency, types, and associations. Stroke 33:728–734CrossRefPubMed Dennis MS, Lo KM, McDowall M, West T (2002) Fractures after stroke: frequency, types, and associations. Stroke 33:728–734CrossRefPubMed
11.
Zurück zum Zitat Gerber Y, Melton LJ 3rd, McNallan SM, Jiang R, Weston SA, Roger VL (2013) Cardiovascular and noncardiovascular disease associations with hip fractures. Am J Med 126(169):e119–e126 Gerber Y, Melton LJ 3rd, McNallan SM, Jiang R, Weston SA, Roger VL (2013) Cardiovascular and noncardiovascular disease associations with hip fractures. Am J Med 126(169):e119–e126
12.
Zurück zum Zitat Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49:553–558CrossRefPubMed Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49:553–558CrossRefPubMed
13.
Zurück zum Zitat Belagaje SR (2017) Stroke rehabilitation. Continuum (Minneap Minn) 23:238–253 Belagaje SR (2017) Stroke rehabilitation. Continuum (Minneap Minn) 23:238–253
15.
Zurück zum Zitat Kerse N, Parag V, Feigin VL, McNaughton H, Hackett ML, Bennett DA, Anderson CS, Auckland Regional Community Stroke Study G (2008) Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003. Stroke 39:1890–1893CrossRefPubMed Kerse N, Parag V, Feigin VL, McNaughton H, Hackett ML, Bennett DA, Anderson CS, Auckland Regional Community Stroke Study G (2008) Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003. Stroke 39:1890–1893CrossRefPubMed
16.
Zurück zum Zitat Youm T, Aharonoff G, Zuckerman JD, Koval KJ (2000) Effect of previous cerebrovascular accident on outcome after hip fracture. J Orthop Trauma 14:329–334CrossRefPubMed Youm T, Aharonoff G, Zuckerman JD, Koval KJ (2000) Effect of previous cerebrovascular accident on outcome after hip fracture. J Orthop Trauma 14:329–334CrossRefPubMed
17.
Zurück zum Zitat Chiu KY, Pun WK, Luk KD, Chow SP (1992) A prospective study on hip fractures in patients with previous cerebrovascular accidents. Injury 23:297–299CrossRefPubMed Chiu KY, Pun WK, Luk KD, Chow SP (1992) A prospective study on hip fractures in patients with previous cerebrovascular accidents. Injury 23:297–299CrossRefPubMed
18.
Zurück zum Zitat Kramer AM, Steiner JF, Schlenker RE, Eilertsen TB, Hrincevich CA, Tropea DA, Ahmad LA, Eckhoff DG (1997) Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings. JAMA 277:396–404PubMed Kramer AM, Steiner JF, Schlenker RE, Eilertsen TB, Hrincevich CA, Tropea DA, Ahmad LA, Eckhoff DG (1997) Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings. JAMA 277:396–404PubMed
19.
Zurück zum Zitat Poplingher AR, Pillar T (1985) Hip fracture in stroke patients. Epidemiology and rehabilitation. Acta Orthop Scand 56:226–227CrossRefPubMed Poplingher AR, Pillar T (1985) Hip fracture in stroke patients. Epidemiology and rehabilitation. Acta Orthop Scand 56:226–227CrossRefPubMed
20.
Zurück zum Zitat 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 131:158–163CrossRefPubMed 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 131:158–163CrossRefPubMed
21.
Zurück zum Zitat Fisher A, Srikusalanukul W, Davis M, Smith P (2013) Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention. Stroke Res Treat 2013:641943PubMedPubMedCentral Fisher A, Srikusalanukul W, Davis M, Smith P (2013) Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention. Stroke Res Treat 2013:641943PubMedPubMedCentral
22.
Zurück zum Zitat Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163CrossRefPubMed Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163CrossRefPubMed
23.
Zurück zum Zitat Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91:922–927CrossRefPubMed Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91:922–927CrossRefPubMed
24.
Zurück zum Zitat Parvizi J, Ereth MH, Lewallen DG (2004) Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am 86-A:1983–1988CrossRefPubMed Parvizi J, Ereth MH, Lewallen DG (2004) Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am 86-A:1983–1988CrossRefPubMed
25.
Zurück zum Zitat Karatepe AG, Gunaydin R, Kaya T, Turkmen G (2008) Comorbidity in patients after stroke: impact on functional outcome. J Rehabil Med 40:831–835CrossRefPubMed Karatepe AG, Gunaydin R, Kaya T, Turkmen G (2008) Comorbidity in patients after stroke: impact on functional outcome. J Rehabil Med 40:831–835CrossRefPubMed
26.
Zurück zum Zitat Mohamed W, Bhattacharya P, Shankar L, Chaturvedi S, Madhavan R (2015) Which comorbidities and complications predict ischemic stroke recovery and length of stay? Neurologist 20:27–32 Mohamed W, Bhattacharya P, Shankar L, Chaturvedi S, Madhavan R (2015) Which comorbidities and complications predict ischemic stroke recovery and length of stay? Neurologist 20:27–32
27.
Zurück zum Zitat Rakel A, Sheehy O, Rahme E, LeLorier J (2008) Osteoporosis among patients with type 1 and type 2 diabetes. Diabetes Metab 34:193–205CrossRefPubMed Rakel A, Sheehy O, Rahme E, LeLorier J (2008) Osteoporosis among patients with type 1 and type 2 diabetes. Diabetes Metab 34:193–205CrossRefPubMed
28.
Zurück zum Zitat McNair P (1988) Bone mineral metabolism in human type 1 (insulin dependent) diabetes mellitus. Dan Med Bull 35:109–121PubMed McNair P (1988) Bone mineral metabolism in human type 1 (insulin dependent) diabetes mellitus. Dan Med Bull 35:109–121PubMed
29.
Zurück zum Zitat Pedrazzoni M, Ciotti G, Pioli G, Girasole G, Davoli L, Palummeri E, Passeri M (1989) Osteocalcin levels in diabetic subjects. Calcif Tissue Int 45:331–336CrossRefPubMed Pedrazzoni M, Ciotti G, Pioli G, Girasole G, Davoli L, Palummeri E, Passeri M (1989) Osteocalcin levels in diabetic subjects. Calcif Tissue Int 45:331–336CrossRefPubMed
30.
Zurück zum Zitat Selby PL, Shearing PA, Marshall SM (1995) Hydroxyproline excretion is increased in diabetes mellitus and related to the presence of microalbuminuria. Diabet Med 12:240–243CrossRefPubMed Selby PL, Shearing PA, Marshall SM (1995) Hydroxyproline excretion is increased in diabetes mellitus and related to the presence of microalbuminuria. Diabet Med 12:240–243CrossRefPubMed
31.
Zurück zum Zitat Napoli N, Chandran M, Pierroz DD, Abrahamsen B, Schwartz AV, Ferrari SL (2016) Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol Napoli N, Chandran M, Pierroz DD, Abrahamsen B, Schwartz AV, Ferrari SL (2016) Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol
32.
Zurück zum Zitat Ivers RQ, Cumming RG, Mitchell P, Peduto AJ, Blue Mountains Eye S (2001) Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care 24:1198–1203 Ivers RQ, Cumming RG, Mitchell P, Peduto AJ, Blue Mountains Eye S (2001) Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care 24:1198–1203
33.
Zurück zum Zitat Vestergaard P, Rejnmark L, Mosekilde L (2005) Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 48:1292–1299CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2005) Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 48:1292–1299CrossRefPubMed
34.
Zurück zum Zitat Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505CrossRefPubMed Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505CrossRefPubMed
35.
Zurück zum Zitat 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 40:3281–3285CrossRefPubMed 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 40:3281–3285CrossRefPubMed
36.
Zurück zum Zitat 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 92:1987–1991CrossRefPubMed 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 92:1987–1991CrossRefPubMed
37.
Zurück zum Zitat Cawthon PM (2011) Gender differences in osteoporosis and fractures. Clin Orthop Relat Res 469:1900–1905 Cawthon PM (2011) Gender differences in osteoporosis and fractures. Clin Orthop Relat Res 469:1900–1905
38.
Zurück zum Zitat Hopkins RB, Pullenayegum E, Goeree R, Adachi JD, Papaioannou A, Leslie WD, Tarride JE, Thabane L (2012) Estimation of the lifetime risk of hip fracture for women and men in Canada. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 23:921–927CrossRef Hopkins RB, Pullenayegum E, Goeree R, Adachi JD, Papaioannou A, Leslie WD, Tarride JE, Thabane L (2012) Estimation of the lifetime risk of hip fracture for women and men in Canada. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 23:921–927CrossRef
39.
Zurück zum Zitat Leavy B, Michaelsson K, Aberg AC, Melhus H, Byberg L (2017) The impact of disease and drugs on hip fracture risk. Calcif Tissue Int 100:1–12 Leavy B, Michaelsson K, Aberg AC, Melhus H, Byberg L (2017) The impact of disease and drugs on hip fracture risk. Calcif Tissue Int 100:1–12
40.
Zurück zum Zitat Joseph C, Kenny AM, Taxel P, Lorenzo JA, Duque G, Kuchel GA (2005) Role of endocrine-immune dysregulation in osteoporosis, sarcopenia, frailty and fracture risk. Mol Asp Med 26:181–201 Joseph C, Kenny AM, Taxel P, Lorenzo JA, Duque G, Kuchel GA (2005) Role of endocrine-immune dysregulation in osteoporosis, sarcopenia, frailty and fracture risk. Mol Asp Med 26:181–201
41.
Zurück zum Zitat Batsis JA, Huddleston JM, Melton LJ, Huddleston PM, Lopez-Jimenez F, Larson DR, Gullerud RE, McMahon MM (2009) Body mass index and risk of adverse cardiac events in elderly patients with hip fracture: a population-based study. J Am Geriatr Soc 57:419–426CrossRefPubMedPubMedCentral Batsis JA, Huddleston JM, Melton LJ, Huddleston PM, Lopez-Jimenez F, Larson DR, Gullerud RE, McMahon MM (2009) Body mass index and risk of adverse cardiac events in elderly patients with hip fracture: a population-based study. J Am Geriatr Soc 57:419–426CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat 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 302:1666–1673CrossRefPubMed 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 302:1666–1673CrossRefPubMed
43.
Zurück zum Zitat Lisabeth LD, Morgenstern LB, Wing JJ, Sanchez BN, Zahuranec DB, Skolarus LE, Burke JF, Kleerekoper M, Smith MA, Brown DL (2012) Poststroke fractures in a bi-ethnic community. J Stroke Cerebrovasc Dis 21:471–477CrossRefPubMed Lisabeth LD, Morgenstern LB, Wing JJ, Sanchez BN, Zahuranec DB, Skolarus LE, Burke JF, Kleerekoper M, Smith MA, Brown DL (2012) Poststroke fractures in a bi-ethnic community. J Stroke Cerebrovasc Dis 21:471–477CrossRefPubMed
44.
Zurück zum Zitat Kiyohara Y, Kubo M, Kato I, Tanizaki Y, Tanaka K, Okubo K, Nakamura H, Iida M (2003) Ten-year prognosis of stroke and risk factors for death in a Japanese community: the Hisayama study. Stroke 34:2343–2347CrossRefPubMed Kiyohara Y, Kubo M, Kato I, Tanizaki Y, Tanaka K, Okubo K, Nakamura H, Iida M (2003) Ten-year prognosis of stroke and risk factors for death in a Japanese community: the Hisayama study. Stroke 34:2343–2347CrossRefPubMed
45.
Zurück zum Zitat Lakshminarayan K, Berger AK, Fuller CC, Jacobs DR Jr, Anderson DC, Steffen LM, Sillah A, Luepker RV (2014) Trends in 10-year survival of patients with stroke hospitalized between 1980 and 2000: the Minnesota stroke survey. Stroke 45:2575–2581CrossRefPubMedPubMedCentral Lakshminarayan K, Berger AK, Fuller CC, Jacobs DR Jr, Anderson DC, Steffen LM, Sillah A, Luepker RV (2014) Trends in 10-year survival of patients with stroke hospitalized between 1980 and 2000: the Minnesota stroke survey. Stroke 45:2575–2581CrossRefPubMedPubMedCentral
46.
Zurück zum Zitat Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP (2009) Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke 40:2068–2072CrossRefPubMed Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP (2009) Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke 40:2068–2072CrossRefPubMed
Metadaten
Titel
Association of stroke subtypes with risk of hip fracture: a population-based study in Taiwan
verfasst von
Jing-Quan Zheng
Hui-Ju Lai
Cai-Mei Zheng
Yu-Chun Yen
Kuo-Cheng Lu
Chaur-Jong Hu
Hsun-Hua Lee
Yuan-Hung Wang
Publikationsdatum
01.12.2017
Verlag
Springer London
Erschienen in
Archives of Osteoporosis / Ausgabe 1/2017
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-017-0390-8

Weitere Artikel der Ausgabe 1/2017

Archives of Osteoporosis 1/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.