缺血性中风和短暂性脑缺血发作患者发生股骨骨折的风险增加——基于奥地利中风队列的人群观察性二次分析。

The risk of femoral fracture is increased in patients with ischemic stroke and transient ischemic attack-a population-based observational secondary analysis of the Austrian stroke cohort.

作者信息

Heidinger Martin, Lang Clemens, Ferrari Julia, Krebs Stefan, Sykora Marek, Kleyhons Rainer, Resch Heinrich, Karisik Anel, Dejakum Benjamin, Mölgg Kurt, Granna Julian, Boehme Christian, Willeit Peter, Knoflach Michael, Schett Georg, Kiechl Stefan, Lang Wilfried

机构信息

Austrian Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria.

University of Basel, Basel, Switzerland.

出版信息

Int J Stroke. 2025 Jul 23:17474930251364071. doi: 10.1177/17474930251364071.

DOI:10.1177/17474930251364071

PMID:40698909

Abstract

BACKGROUND

An increased risk of femoral fractures after ischemic stroke (IS) and transient ischemic attack (TIA) has been shown previously. However, it remains unclear whether the ischemic cerebral event is directly associated with the risk of femoral fractures.

AIMS

The aim of this study was (1) to assess the association between the frequency of femoral fractures in patient with IS and TIA, and (2) to compare the risk of femoral fractures to the Austrian general population.

METHODS

Population-based observational secondary analysis of the Austrian Stroke Cohort to assess the incidence of femoral fractures in the year after IS/TIA compared with the year before, and both intervals compared with the Austrian general population. All patients ⩾20 years treated for IS/TIA in Austria between 1 January 2016 and 31 December 2018 were identified using medical record linkage. Patient trajectories were reconstructed from 1 January 2015 to 31 December 2019 to have a 1-year observational period before and after the event. Femoral fractures within 1 year after IS/TIA compared to 1 year before IS/TIA were analyzed using McNemar test and Cox regression analysis considering sex and age. The 1-year age- and sex-adjusted relative risk of femoral fractures was calculated for patients with IS/TIA and compared to the Austrian general population.

RESULTS

A total of 48,996 survivors of IS (n = 34,997) and TIA (n = 13,999) were included. The incidence of femoral fractures increased significantly from the year before the IS/TIA (8.9 per 1000 person-years, 95% CI 7.7-10.2) to the year after the event (11.8 per 1000 person-years, 95% CI 10.1-13.5; = 0.022). Compared to the Austrian general population including 21.1 million patient-years at risk and 37,436 femoral fractures, the risk of femoral fractures was increased both in the year before (RR 2.08, 95% CI 2.06-2.11) and after (RR 3.52, 95% CI 3.48-3.56) the IS/TIA.

CONCLUSION

The risk of femoral fractures was found to be increased in the year following an IS/TIA, indicating a direct association with the IS/TIA event.Data access statement:Reconstruction of medical record linkage and individual patient trajectory reconstruction were reported previously. Data from individual patient trajectories was used for this analysis.

摘要

背景

先前已表明，缺血性中风（IS）和短暂性脑缺血发作（TIA）后股骨骨折风险增加。然而，尚不清楚缺血性脑事件是否与股骨骨折风险直接相关。

目的

本研究的目的是（1）评估IS和TIA患者股骨骨折发生率之间的关联，以及（2）将股骨骨折风险与奥地利普通人群进行比较。

方法

对奥地利中风队列进行基于人群的观察性二次分析，以评估IS/TIA后一年与前一年相比股骨骨折的发生率，并将这两个时间段与奥地利普通人群进行比较。通过医疗记录链接确定2016年1月1日至2018年12月31日期间在奥地利接受IS/TIA治疗的所有年龄≥20岁的患者。从2015年1月1日至2019年12月31日重建患者轨迹，以便在事件发生前后有1年的观察期。使用McNemar检验和Cox回归分析，考虑性别和年龄，分析IS/TIA后1年内与IS/TIA前1年相比的股骨骨折情况。计算IS/TIA患者1年年龄和性别调整后的股骨骨折相对风险，并与奥地利普通人群进行比较。

结果

共纳入48,996例IS幸存者（n = 34,997）和TIA幸存者（n = 13,999）。股骨骨折发生率从IS/TIA前一年（每1000人年8.9例，95%CI 7.7 - 10.2）显著增加至事件后一年（每1000人年11.8例，95%CI 10.1 - 13.5；P = 0.022）。与包括2110万患者年风险和37,436例股骨骨折的奥地利普通人群相比，IS/TIA前一年（RR 2.08，95%CI 2.06 - 2.11）和后一年（RR 3.52，95%CI 3.48 - 3.56）股骨骨折风险均增加。