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Stroke Doubles Risk of Hip, Thigh Fractures

Preventive measures urgently needed, researcher says

THURSDAY, Aug. 6 (HealthDay News) -- The risk of a hip or thigh bone fracture is doubled for people who have a stroke, a new Dutch study finds.

That finding shows a need for immediate preventive action after a stroke, said Frank de Vries, an assistant professor of pharmacoepidemiology at the University of Utrecht, and lead author of a report that appears online Aug. 6 in the journal Stroke.

"We know from other studies that bone loss starts rapidly after stroke," de Vries said. "Furthermore, there is evidence from a randomized controlled trial in an Asian population that administration of bisphosphonates, bone-protecting agents, immediately after a stroke reduces bone loss and hip fracture after a year. Other treatments include vitamin D administration, increased mobility, and restoration of motor function. Deformities that limit a normal gait should be corrected. In general, all treatments should be started as early as possible."

Stroke survivors and older people in general should take measures to prevent future falls, de Vries said.

"General fall-preventing strategies include the use of a walking aid, wearing shoes with broad heels and non-slip soles, and minimizing risk factors in and around the home," he said. "A medication review by a doctor or pharmacist may result in discontinuation of drugs that increase risk of falling, such as certain hypnotics and blood pressure-lowering drugs."

The study compared 6,763 people in the Netherlands who had fractures of the hip and/or femur with a group of 26,341 people matched for age, gender and location who had no such fractures. The overall risk of fractures was 1.96 times higher for all stroke survivors and 2.12 times higher among women who had strokes.

The youngest stroke survivors, those 70 or younger, had the highest risk: 5.12 times normal, the researchers found.

The study was not designed to give information about the reasons for the age difference, but "we believe that in elderly patients, the relative contribution of risk factors other than stroke is higher," de Vries said.

While the findings came from a homogenous Dutch group, they probably apply to stroke victims in the more diverse U.S. population, he said. "There are some differences in ethnicity, but previous epidemiological studies in the U.S. have reported increased risk of hip fractures in Mexican Americans and black people as well," de Vries said.

In the United States, the National Osteoporosis Society estimates that 300,000 people have hip fractures every year, and that 20 percent of them die within a year of the fracture, he said.

In the Dutch study, the average age of the participants was 75, and 73 percent of them were women. The average time between a stroke and a fracture was 2.2 years, the study authors noted.

The new study is one of several that "highlight a great preventive medicine opportunity," said Dr. Heather E. Whitson, an assistant professor of medicine in the division of geriatrics at Duke University, who reported similar findings in a study of Veterans Administration hospitals several years ago.

"Most efforts at treating stroke focus on preventing future stroke," Whitson said. "What this focuses on is something we've seen more of recently, as the population ages, that one problem can raise the risk of a seemingly unrelated problem."

In the past, most stroke survivors did not live long enough to fall victim to a fracture or other major problem, Whitson said. "One of the main things we need to do is recognize fracture as a non-infrequent complication of the post-stroke patient. That recognition can help us prevent other major problems from happening."

More information

Advice on healthy living after a stroke is offered by the American Stroke Association.

SOURCES: Frank de Vries, Ph.D., assistant professor, pharmacoepidemiology, University of Utrecht, Netherlands; Heather E. Whitson, M.D., assistant professor, medicine, division of geriatrics, Duke University, Durham, N.C.; Aug. 6, 2009, Stroke, online

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