Only 8 years old. How incompetent is your stroke hospital if they haven't put this into place yet? Seems like a fireable offense for the hospital board of directors to enforce. Why would you even go to a hospital if they can't even read and apply research to their areas of expertise? The following of Joint Commission standards is even more of a reason to never set foot in such a hospital. No innovation. But then I'm a stupid non-medical stroke survivor, they would have to be stupider than me to not see where they can apply research to stroke protocols.
http://jama.jamanetwork.com/article.aspx?articleid=200453
Context
Stroke increases the risk of subsequent hip fracture by 2 to 4 times.
Hyperhomocysteinemia is a risk factor for both ischemic stroke and osteoporotic
fractures in elderly men and women. Treatment with folate and mecobalamin
(vitamin B12) may improve hyperhomocysteinemia.
Objective
To investigate whether treatment with folate and vitamin B12 reduces
the incidence of hip fractures in patients with hemiplegia following stroke.
Design, Setting, and Patients
A double-blind, randomized controlled study of 628 consecutive patients
aged 65 years or older with residual hemiplegia at least 1 year following
first ischemic stroke, who were recruited from a single Japanese hospital
from April 1, 2000, to May 31, 2001. Patients were assigned to daily oral
treatment with 5 mg of folate and 1500 μg of mecobalamin, or double placebo;
559 completed the 2-year follow-up.
Main Outcome Measure
Incidence of hip fractures in the 2 patient groups during the 2-year
follow-up.
Results
At baseline, patients in both groups had high levels of plasma homocysteine
and low levels of serum cobalamin and serum folate. After 2 years, plasma
homocysteine levels decreased by 38% in the treatment group and increased
by 31% in the placebo group (P<.001). The number
of hip fractures per 1000 patient-years was 10 and 43 for the treatment and
placebo groups, respectively (P<.001). The adjusted
relative risk, absolute risk reduction, and the number needed to treat for
hip fractures in the treatment vs placebo groups were 0.20 (95% confidence
interval [CI], 0.08-0.50), 7.1% (95% CI, 3.6%-10.8%), and 14 (95% CI, 9-28),
respectively. No significant adverse effects were reported.
Conclusion
In this Japanese population with a high baseline fracture risk, combined
treatment with folate and vitamin B12 is safe and effective in
reducing the risk of a hip fracture in elderly patients following stroke.
The risk of a hip fracture in patients after stroke is 2 to 4 times
higher than that in age-matched healthy control patients.
1 These
fractures usually occur relatively late after stroke onset and affect the
paretic side of the body.
2- 5 Hip
fractures are associated with more deaths, disabilities, and medical costs
than all other osteoporosis-related fractures combined.
6 We
previously measured the bone mineral density (BMD) in patients with stroke
in the second metacarpal bone and demonstrated a decrease in the bone mass
in the hemiplegic limb that corresponded to the degree of palsy and vitamin
D deficiency,
7 which may explain why hip fractures
in patients poststroke occur almost exclusively on the hemiplegic side of
the body.
A close association between plasma homocysteine and risk of ischemic
stroke has been reported,
8- 11 and
plasma homocysteine levels are higher in patients with ischemic stroke in
both acute
12- 13 and convalescent
phases.
14- 17 In
patients with homocysteinuria, a rare autosomal recessive biochemical abnormality,
there is an increased prevalence of skeletal abnormalities,
18- 20 including
osteoporosis, a primary risk factor for hip fracture. Thus, elevated plasma
homocysteine concentrations may be associated with osteoporosis and increase
the risk of a hip fracture. An increased homocysteine level appears to be
a strong and independent risk factor for an osteoporotic fracture of the bones,
including the hip, in older men and women.
21- 22
In the remethylation cycle, homocysteine is salvaged for methionine
synthesis by the addition of a methyl group by methionine synthase.
23 Vitamin B
12 (cobalamin) is an essential
cofactor for methionine synthase and
N5-methyl-tetrahydrofolate
serves as the methyl donor. Therefore, there are close relationships between
plasma homocysteine and cobalamin and folate.
8- 9,24- 26
We previously demonstrated a reduction in plasma homocysteine levels
by combination therapy with folate and vitamin B
12 in patients
with ischemic stroke.
26 Our goal for this study
was to investigate the efficacy of the combined therapy for decreasing the
risk of fractures, particularly in the hip, in a 2-year trial in elderly patients
with hemiplegia following ischemic stroke.
