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No Bones About It, Stroke Ups Risk of Fractures

WebMD Health News

April 13, 2001 -- People who have suffered a stroke are at greater risk of falling and sustaining a fracture than other people, partly because they may be unsteady on their feet for some time after the stroke.


"Stroke patients have weakness on one side that could make them unsteady, so they tend to fall. And if they fall they tend to fracture," says stroke expert John Gilroy, MD, chairman of neurology at the William Beaumont Hospital in Royal Oak, Mich.


"Certain types of stroke are associated with an unsteadiness and a wide-based gait, and if people are at all nudged by, say, a doorknob, they can be knocked off balance and they fall," he tells WebMD. Also, messages from the limbs to the brain may be impaired as a result of stroke, which also increases the risk of a fall.


The risk of falling and fracture is the greatest right after the stroke, according to a study in the April issue of Stroke. The new findings highlight an important need for fall prevention strategies, such as medications to build bone, hip-protecting garments, regular tests to measure bone density, and the use of canes or walkers, immediately after a stroke.


A stroke, or "brain attack," occurs when a blood clot blocks a blood vessel or artery or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the immediate area. It is the third leading cause of death in the U.S., killing nearly 160,000 Americans every year. Often people who survive a stroke experience difficulty with mobility.


The Stroke study looked at more than 270,000 people hospitalized for stroke in Swedish hospitals. Of these, 9% sustained a fracture -- and more than half were hip fractures.


Overall, the risk of sustaining any fracture was seven times higher the year following hospitalization for stroke. The risk for hip fracture, in particular, was four times higher immediately following stroke, compared with risk of hip fracture among the general population.


However, risk of fracture declined over time, according to study author John Kanis, MD, of the Center for Metabolic Bone disease at the University of Sheffield Medical School in England.


"The high incidence of new fractures within the first year of hospitalization for stroke suggests that such patients should be preferentially targeted for treatment. It is possible that short courses of treatment at the time of stroke would provide important therapeutic [benefits]," Kanis reports.


Risk of fracture varied by age and sex, Kanis and colleagues found. Overall, risk of fracture was higher in women than in men. And in people aged 50-54, the fracture risk was up to 12 times higher than those in the general population.

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