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(Stroke. 2009;40:3281.)
© 2009 American Heart Association, Inc.

Original Contributions

Risk of Hip/Femur Fracture After Stroke

A Population-Based Case-Control Study

Sander Pouwels, PharmD; Arief Lalmohamed, BSc; Bert Leufkens, PhD; Anthonius de Boer, MD, PhD; Cyrus Cooper, MD, FMedSci; Tjeerd van Staa, MD, PhD Frank de Vries, PhD

From Utrecht Institute for Pharmaceutical Sciences (S.P., A.L., B.L., A.d.B., T.v.S., F.d.V.), Division of Pharmacoepidemiology and Pharmacotherapy, University Utrecht, Utrecht, The Netherlands; MRC Epidemiology Resource Centre (C.C., T.v.S., F.d.V.), University of Southampton, Southampton General Hospital, Southampton, UK; Institute of Musculoskeletal Sciences (C.C.), University of Oxford, Oxford, UK.

Correspondence to Frank de Vries, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands. E-mail f.devries{at}uu.nl

Background and Purpose— Stroke increases the risk of hip/femur fracture, as seen in several studies, although the time course of this increased risk remains unclear. Therefore, our purpose is to evaluate this risk and investigate the time course of any elevated risk.

Methods— We conducted a case-control study using the Dutch PHARMO Record Linkage System database. Cases (n=6763) were patients with a first hip/femur fracture; controls were matched by age, sex, and region. Odds ratio (OR) for the risk of hip/femur fracture was derived using conditional logistic regression analysis, adjusted for disease and drug history.

Results— An increased risk of hip/femur fracture was observed in patients who experienced a stroke at any time before the index date (adjusted OR, 1.96; 95% CI, 1.65–2.33). The fracture risk was highest among patients who sustained a stroke within 3 months before the index date (adjusted OR, 3.35; 95% CI, 1.87–5.97) and among female patients (adjusted OR, 2.12; 95% CI, 1.73–2.59). The risk further increased among patients younger than 71 years (adjusted OR, 5.12; 95% CI, 3.00–8.75). Patients who had experienced a hemorrhagic stroke tended to be at a higher hip/femur fracture risk compared with those who had experienced an ischemic stroke.

Conclusions— Stroke is associated with a 2.0-fold increase in the risk of hip/femur fracture. The risk was highest among patients younger than 71 years, females, and those whose stroke was more recent. Fall prevention programs, bone mineral density measurements, and use of bisphosphonates may be necessary to reduce the occurrence of hip/femur fractures during and after stroke rehabilitation.

Key Words: bone density • fracture • risk factors • stroke