Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Department of Medicine, University of California at Los Angeles, Los Angeles, CA.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104976. doi: 10.1016/j.jstrokecerebrovasdis.2020.104976. Epub 2020 Jun 10.
Hip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk.
The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death.
Average age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant.
Severe disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.
髋部骨折是中风后的一种严重并发症。我们利用妇女健康倡议（WHI）的数据，研究了中风后髋部骨折风险的预测因素。具体来说，我们研究了中风后残疾水平与髋部骨折风险之间的关系。
WHI 是一项针对 161808 名 50-79 岁绝经后女性的前瞻性研究。经过培训的医生裁定中风事件和髋部骨折。我们的研究包括观察性和临床试验臂中的中风幸存者，他们的格拉斯哥结局量表为良好恢复、中度残疾或重度残疾，并且在中风后存活超过 7 天。比较了不同残疾水平下的髋部骨折无发生情况。二次分析在考虑死亡竞争风险的情况下检查了髋部骨折风险。
中风时的平均年龄为 74.6±7.2 岁；84.3%为白人。在平均随访时间为 3.1±1.8 年期间，4640 例中风幸存者中有 124 例发生髋部骨折。死亡率为 23.3%。出院时严重残疾（风险比（HR）：2.1（95%置信区间（CI）：1.4-3.2），而不是中度残疾（HR：1.1（95%CI：0.7-1.7））与良好恢复状态相比，髋部骨折风险显著增加。这种关联在考虑死亡率后减弱。白人种族、年龄增长和更高的骨折风险评估工具（FRAX）预测的髋部骨折风险（无骨密度信息）与髋部骨折风险增加相关。在考虑死亡率后，更高的 FRAX 风险和白人种族仍然具有统计学意义。
中风后严重残疾和更高的 FRAX 风险评分与随后髋部骨折的风险相关。在考虑死亡率后，只有 FRAX 风险评分仍然具有统计学意义。FRAX 风险评分似乎可以识别出骨折风险较高的中风幸存者。我们的结果表明，中风病房可以考虑将骨质疏松症筛查纳入护理路径。
