Fracture Risk Among Stroke Survivors According to Poststroke Disability Status and Stroke Type

 I look at this totally differently; what do I do to strengthen my bones so they won't fracture.  Boxers microfracturing their hands so they recover stronger than they were. Of course your doctor will never approve of you falling to stress your bones. I have fallen numerous times on my left hip, including at least six times from my bicycle. I look at that as probably preventing much worse outcomes as I get older. Don't listen to me, I'm not medically trained; Is your doctor?

Fracture Risk Among Stroke Survivors According to Poststroke Disability Status and Stroke Type

Dagyeong Lee,

In Young Cho,

Won Hyuk Chang,

Jung Eun Yoo,

Hea Lim Choi,

Junhee Park,

Dong Wook Shin and

Kyungdo Han

Originally published30 Apr 2024https://doi.org/10.1161/STROKEAHA.123.044953Stroke. 2024;0

Abstract

BACKGROUND:

Stroke survivors face physical and cognitive challenges, leading to an increased dependency and a higher fall risk. We aimed to investigate the impact of poststroke disability and stroke type on fracture risk at various sites compared with matched controls.

METHODS:

This retrospective cohort study used data from the Korean National Health Insurance System database (2010–2018), including patients with stroke and 1:1 matched controls. Stroke survivors were grouped based on the presence and severity of their poststroke disability and stroke type. The primary outcome was a newly diagnosed fracture, analyzed by Cox proportional hazard regression analyses adjusting for potential confounders.

RESULTS:

Among 223 358 stroke survivors (mean age, 64.8±10.9 years; 61.2% men), 16 344 fractures occurred during a mean follow-up of 3.7±2.5 years. In matched controls (n=322 161; mean age, 65.4±11.2 years; 61.3% men), 20 398 fractures were identified. Stroke survivors had increased overall fracture risk compared with matched controls (adjusted hazard ratio [aHR], 1.40 [95% CI, 1.37–1.43]). Specifically, hip fracture risk was even greater in stroke survivors (incidence rate per 1000 person-years, 4.7 [95% CI, 4.5–4.8]; aHR, 2.42 [95% CI, 2.30–2.55]) than controls (incidence rate, 2.2 [95% CI, 2.1–2.3]). The risk of vertebral fractures (aHR, 1.29 [95% CI, 1.25–1.34]) and other fractures (aHR, 1.19 [95% CI, 1.15–1.23]) was also higher than that of the control group. Hip fracture risk was the highest among stroke survivors with severe poststroke disability (aHR, 4.82 [95% CI, 4.28–5.42]), although vertebral or other fracture risk was the highest among those with mild poststroke disability. No significant difference in fracture risk was found between hemorrhagic and ischemic stroke survivors when stratified by disability status.

CONCLUSIONS:

Our findings showed increased subsequent fracture risk among stroke survivors, particularly those with poststroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.

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Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

Did your competent? doctor get you walking far enough to prevent this? Or don't you have a functioning stroke doctor?

Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

Dana Bliuc, PhD^1,2,3; Thach Tran, PhD^1,4; Dunia Alarkawi, MPH, MHM^1,4; et al Weiwen Chen, PhD¹; Dima A. Alajlouni, MScMed^1,4; Fiona Blyth, PhD⁵; Lyn March, PhD⁶; Robert D. Blank, PhD¹; Jacqueline R. Center, PhD^1,4

Author Affiliations Article Information

JAMA Netw Open. 2024;7(1):e2352675. doi:10.1001/jamanetworkopen.2023.52675

Key Points

Question  Are adults aged 45 years and older with a walking ability limitation at a higher fracture risk compared with same-age adults without a walking limitation?

Findings  In this cohort study with 238 969 persons, 1 in 5 reported a limitation in walking 1000 m or less. Walking limitation was significantly associated with between a 32% and 219% higher fracture risk and contributed to approximately 60% of fractures.

Meaning  In this study, self-reported walking limitations were common; given that they are easily detected, they should be sought by clinicians to identify high-risk candidates for further bone assessment.

Abstract

Importance  The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated.

Objective  To examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture.

Design, Setting, and Participants  This prospective cohort study compared individuals with various degrees of walking ability limitation at 1000 m (a little limitation and a lot of limitation) and those without limitation (no limitation) accounting for age, falls, prior fractures, and weight. Participants from the ongoing population-based Sax Institute 45 and Up Study were followed from recruitment (2005-2008) for 5 years (2010-2013). Data analysis was conducted from July 2020 to September 2023.

Exposure  Self-reported walking limitation.

Main Outcomes and Measures  Incident fracture and site-specific fractures (hip, vertebral, and nonhip nonvertebral [NHNV] fractures).

Results  Among the 266 912 participants enrolled in the 45 and Up Study, 238 969 were included, with 126 015 (53%) women (mean [SD] age, 63 [11] years) and 112 954 (47%) men (mean [SD] age, 61 [11] years). Approximately 20% reported a degree of limitation in walking 1000 m or less at baseline (39 324 women [24%]; 23 191 men [21%]). During a mean (SD) follow-up of 4.1 (0.8) years, 7190 women and 4267 men experienced an incident fracture. Compared with participants who reported no walking limitations, a little limitation and a lot of limitation were associated with higher risk of fracture (a little limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; a little limitation among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; a lot of limitation among men: HR, 2.03; 95% CI, 1.86-2.22). Approximately 60% of fractures were attributable to walking limitation. The association was significant for hip, vertebral, and NHNV fracture and ranged between a 21% increase to a greater than 219% increase.

Conclusions and Relevance  In this cohort study of 238 969 participants, self-reported walking limitations were associated with increased risk of fracture. These findings suggest that walking ability should be sought by clinicians to identify high-risk candidates for further assessment.(NO, NO, NO! You blithering idiots need to provide protocols that solve this! ASSESSMENTS DO FUCKING NOTHING FOR RECOVERY!

Fracture Risk Increases After Stroke or Transient Ischemic Attack and Is Associated With Reduced Quality of Life

What is your doctors EXACT FALL PREVENTION PROTOCOL? If it's not 100% recovery, you don't have a functioning stroke doctor!

Fracture Risk Increases After Stroke or Transient Ischemic Attack and Is Associated With Reduced Quality of Life

Lachlan L. Dalli,

Karen Borschmann,

Shae Cooke,

Monique F. Kilkenny,

Nadine E. Andrew,

David Scott,

Peter R. Ebeling,

Natasha A. Lannin,

Rohan Grimley,

Vijaya Sundararajan,

… See all authors

Originally published15 Aug 2023https://doi.org/10.1161/STROKEAHA.123.043094Stroke. 2023;54:2593–2601

Abstract

BACKGROUND:

Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA.

METHODS:

Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009–2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture.

RESULTS:

Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%–80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05–1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21–1.50]), history of prior fracture(s; IRR, 2.56 [95% CI, 1.77–3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10–1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49–0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort.

CONCLUSIONS:

Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.

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Risk of Fractures in Stroke Patients Treated With a Selective Serotonin Reuptake Inhibitor

Just in case your doctor did not get the memo that SSRIs originally thought to help rehab do not really help. Good thing I was only on these for a couple of months because I fell a lot on my left hip in order to strengthen it and prevent breaking my hip when I really get old. Don't listen to me, I'm not medically trained.

A while ago SSRIs were considered helpful in recovery.

Common antidepressant can help stroke patients improve movement and coordination Sept. 2015 

 

Antidepressants may help people recover from stroke even if they are not depressed Jan. 2013

  

 Have your doctor explain why  this discrepancy occurred between the upper two and this lower one.

 Then further research disproved that. 

 

Is there a suitable drug for stroke recovery?

The latest here:

Risk of Fractures in Stroke Patients Treated With a Selective Serotonin Reuptake Inhibitor

A Systematic Review and Meta-Analysis

Joshua S. Jones

,

Rina Kimata

,

Osvaldo P. Almeida

,

Graeme J. Hankey

Originally published25 Jun 2021https://doi.org/10.1161/STROKEAHA.120.032973Stroke. ;0:STROKEAHA.120.032973

Abstract

Background and Purpose:

Stroke survivors have an increased risk of depression and bone fractures. Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of fractures in observational studies. Several randomized controlled trials (RCTs) reporting the effect of SSRIs on the risk of fractures in stroke survivors have been published recently but have not been subject to a meta-analysis. We aimed to determine the risk of fractures associated with the use of SSRIs, and the risk of falls, seizures, and recurrent strokes as possible mediators of fractures, in stroke survivors.

Methods:

We conducted a systematic review and meta-analysis of RCTs of SSRIs in stroke survivors according to a protocol registered in PROSPERO (CRD42020192632). Web of Science, EMBASE, PsycINFO, and Ovid Medline/PubMed bibliographic databases, clinical trial registers, and grey literature sources were searched. RCTs of SSRIs versus placebo or no intervention that report the risk of fractures in adult survivors of hemorrhagic or ischemic stroke were included. Two reviewers independently screened search results and extracted data. Meta-analyses were conducted for each outcome using the Mantel-Haenszel random-effects models.

Results:

The searches yielded 683 records, of which 4 RCTs of 6 months duration with a total of 6549 participants were included in the meta-analysis: 3 studies of fluoxetine and 1 study of citalopram. Treatment with an SSRI for 6 months increased the risk of fractures with a risk ratio of 2.36 (95% CI, 1.64–3.39) compared with placebo. The risk of falls, seizures, and recurrent stroke was not statistically significantly increased. Only studies of fluoxetine and citalopram were available for inclusion in the review, and hence the generalizability of the findings to other SSRIs is uncertain.

Conclusions:

Based on available RCTs of fluoxetine and citalopram, SSRIs used for 6 months doubled the risk of fractures in stroke survivors.(So unless your doctors and therapists have a perfect fall prevention protocol you probably don't want this.)

Registration:

URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020192632.

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Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies

So ask your doctor if this is the 81 or 325 dosage. Or is your doctor worried about the gastrointestinal bleeding risk?  And thus doesn't recommend aspirin at all? Listen to your doctor, not me, but ask plenty of questions.

In 2014, the FDA reversed its stance on daily low-dose aspirin as a
primary source of heart disease prevention, citing clearly established
side effects such as brain and stomach bleeding, as well as a lack of
clear benefit for patients who have never experienced a heart attack,
stroke or cardiovascular disease.

Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies

1. A L Barker1,2,
2. Sze-Ee Soh1,3,
3. Kerrie M Sanders4,5,
4. Julie Pasco6,
5. Sundeep Khosla7,
6. Peter R Ebeling8,
7. Stephanie A Ward1,
8. Geeske Peeters9,
9. Jason Talevski4,5,
10. Robert G Cumming10,
11. Ego Seeman11,12,
12. John J McNeil1

Abstract

Objectives This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin.

Methods We conducted a systematic review and exploratory meta-analysis of observational studies. Electronic searches of MEDLINE and Embase, and a manual search of bibliographies was undertaken for studies published to 28 March 2018. Studies were included if: participants were men or women aged ≥18 years; the exposure of interest was aspirin; and relative risks, ORs and 95% CIs for the risk of fracture or difference (percentage or absolute) in BMD (measured by dual energy X-ray absorptiometry) between aspirin users and non-users were presented. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for observational studies. Pooled ORs for any fracture and standardised mean differences (SMDs) for BMD outcomes were calculated using random-effects models.

Results Twelve studies met the inclusion criteria and were included in the meta-analysis. Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I²=71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI −0.02 to 0.07; I²=0%; three studies; n=9686) and men (SMD 0.06, 95% CI −0.02 to 0.13, I²=0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI −0.03 to 0.09; I²=34%; four studies; n=11 330) and men (SMD 0.08; 95% CI −0.01 to 0.18; one study; n=432).

Conclusions While the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Physicians: B.E.D. In Adults - B.E.D. Symptoms In Adults

B

Warfarin use and fracture risk: an evidence-based mechanistic insight

Something for your doctor to maybe warn you about.
http://link.springer.com/article/10.1007/s00198-014-2912-1

This is an excerpt from the content

Dear Editor,

There is a long-standing debate on the association between use of warfarin, prescribed to millions of people to decrease their risk of clotting, and fracture risk [1]. In a large population-based cohort in the UK, Misra and colleagues [2] found that warfarin use was not linked to an increase in fracture risk. Here, we would like to present an evidence-based, reasonable insight into the mechanisms by which this drug affects bone strength.

Osteocalcin, the most abundant non-collagenous protein in bone, is incorporated into bone through vitamin K-dependent γ-carboxylation. Warfarin, a vitamin K antagonist, decreases osteocalcin content in bone and impairs bone material hardness in rats [3], which is consistent with data in mice that osteocalcin deficiency causes a decrease in bone tissue hardness [4]. Consistently, in older patients undergoing chronic therapy with oral vitamin K antagonists [5], undercarboxylated osteocalcin levels in blood were inversely related to cortical ul ...

Falls, Fractures, and Osteoporosis After Stroke

This must not have affected me too much considering  my epic failure at bike stroke therapy  My doctor had 4 years to read about this and never told me to watch out for this.
 http://stroke.ahajournals.org/content/33/5/1432.short

Time to Think About Protection?

1. Kenneth E.S. Poole, BM, MRCP;
2. Jonathan Reeve, DM, BSc, FRCP;
3. Elizabeth A. Warburton, MA, DM, MRCP

+ Author Affiliations

1. From the Department of Stroke Medicine (K.E.S.P., E.A.W.) and Medical Research Council Bone Research Group (J.R.), Addenbrooke’s Hospital, Cambridge, UK.

1. Correspondence to Dr Elizabeth A. Warburton, Department of Stroke Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Box 83, Cambridge CB2 2QQ, UK. E-mail eaw23@medsch1.cam.ac.uk

Abstract

Background— Osteoporosis is a significant complication of stroke. The clinical course of hemiplegic stroke predisposes patients to disturbed bone physiology. Sudden immobility and unilateral loss of function unload the skeleton at key areas such as the affected hip. This is manifest by an early reduction in bone density at this site. Stroke patients may also have motor, sensory, and visual/perceptual deficits that predispose them to falls. These factors result in an early but sustained increase in hip fractures after stroke.

Summary of Comment— Potential bone loss is often overlooked in stroke treatment. Morbidity and mortality from hip fractures might be reduced by preventing bone loss at an early stage. In the crucial first year after stroke, bone loss seems to be due to accelerated resorption. Bisphosphonates are the drugs of choice in preventing osteoclastic bone resorption, but oral administration soon after stroke may be impractical. Potent new intravenous bisphosphonates have been used in postmenopausal women with osteoporosis with good preliminary results. Effective dosing regimens for osteoporosis have included a single annual or semiannual injection of bisphosphonate as well as weekly oral dosing. This article reviews the current literature on osteoporosis and hip fractures after stroke, making a case for a trial of intravenous bisphosphonates early after stroke.

Conclusions— Hip fracture after stroke is an increasingly recognized problem. Measures to prevent bone loss and preserve bone architecture have not been part of stroke management thus far. Because rapid bone loss is a risk factor for fracture, we believe that a randomized, placebo-controlled trial of intravenous bisphosphonates given in the early phase of stroke rehabilitation is indicated.

Clopidogrel May Increase Fracture Risk in Patients Who Have Had a Stroke

Be careful out there. Remember you need to know all this stuff.
http://www.docguide.com/clopidogrel-may-increase-fracture-risk-patients-who-have-had-stroke?hash=7e422beb&eid=35318&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c
Patients who have had a stroke, who are at an already increased risk for fractures, may be at further increased risk if they are being treated with the platelet-inhibitor clopidogrel, according to a retrospective, cohort study presented at the American Society of Bone and Mineral Research (ASBMR) 2013 Annual Meeting.
“Clinicians may not take care of patients’ bone health when they present with a stroke,” noted lead author Niklas RyeJørgensen, MD, PhD, Copenhagen University Hospital Glostrup, Glostrup, Denmark, speaking here on October 5. Most patients who have had a stroke, he added, receive platelet inhibitor therapy with clopidogrel, which has been shown to be associated with an increased risk of fracture.
Dr. Jorgensen and colleagues included 77,503 Danish patients who had been prescribed clopidogrel during the years 1996 to 2008 as exposed subjects. For each of these exposed subjects, 3 subjects of the same age and gender were randomly selected as controls (n = 232,510).
Patients treated with clopidogrel had more strokes compared with the control group (1.2% vs 0.9%, respectively), more ischaemic strokes (9.3% vs 2.6%), and more transient ischaemic attacks (TIAs) (7.2% vs 2.3%).
Patients who have had a stroke had a significantly increased risk of fractures, both in the haemorrhagic stroke group (hazard ratio [HR]: 1.34, P< .001) and the ischaemic stroke group (HR: 1.54, P< .001).
Patients who have had a TIA also had an increased risk of fractures (HR: 1.28, P< .001), as did clopidogrel users (HR: 1.05, P< .001), although the researchers note that the contribution of clopidogrel treatment was much less than the contribution of the stroke itself.
A number of factors contributed to an increased risk of fractures in patients who have had a stroke, the researchers outlined. Patients who have had a stroke have several risk factors for bone loss, including decompensation, treatment with agents that can lead to increased bone resorption (and thereby bone loss), vitamin D insufficiency, and an increased risk of falls, primarily because of changes in these values and changes in muscular function.
“We should definitely recommend to clinicians to take care of bone health in stroke patients,” Dr. Jorgensen concluded.
Patients in this study were culled from 3 databases in Denmark: the National Hospital Discharge Register, the Psychiatric Central Register, and the National Pharmacological Database of the Danish Health & Medicines Agency.