Aug. 9, 2000 -- Strokes and hip fractures are two of the most common maladies affecting the elderly, and they are among the most debilitating. It now appears the two are linked more often than has previously been believed, and that the risk of hip fractures in stroke survivors is growing.
In a previous study, researchers from Sweden's Umea University concluded that elderly stroke survivors had four times the risk of hip fractures as their counterparts who had not had strokes.
In their most recent report, published in the July issue of the journal Stroke, the researchers found that almost 40% of patients being treated for hip fractures at a Swedish treatment center reported previous strokes.
The authors suggest that as the population ages, the incidence of stroke-related hip fractures will continue to grow for the foreseeable future, unless prevention efforts are implemented.
"We are not exactly sure why we are seeing this increase in hip fractures among people who have had strokes. One obvious answer is that stroke patients are living longer and their strokes may be less severe, but this does not tell the whole story," study author Yngve Gustafson, MD, tells WebMD. "There is also an increase in osteoporosis among these patients."
Stroke survivors with long-term or permanent paralysis are at increased risk for significant bone loss known as osteoporosis, which, in turn, increases the risk of fractures. Surprisingly, survivors included in this study appeared to be at greatest risk for hip fractures several years after a stroke instead of during stroke rehabilitation. Fractures occurred in this group an average of three years after the stroke occurred.
"This study reinforces the notion that stroke patients should at least be tested for osteoporosis, and should be treated if appropriate," George Hademenos, MD, of the American Stroke Association (ASA) tells WebMD. "And it shows that fractures don't generally occur right after a stroke when the patient is still being very careful. Instead, they often happen three and four years after the stroke, suggesting patients should always be careful. They should not get too comfortable with their surroundings or abilities." Hademenos, a staff scientist with the ASA, was not involved with the study.
Not surprisingly, hip fracture patients who reported previous strokes had worse outcomes following fractures than those who had not had strokes. One year after hip fracture, nearly a third of those who had prior strokes had died, compared to 17% of those without strokes. At five years after fracture, 80% of stroke patients had died, compared to 60% of those who had not had strokes.
In patients who reported having good mobility prior to their hip fracture, over two-thirds were still able to move around after being treated for the fracture, compared to just over a third of those reporting an earlier stroke.
"Preventing hip fractures in stroke patients is very important, and it is an issue that has not been given much attention," Hademenos says. "It is important for both the patient and the physician to keep in mind that these fractures happen, they can be very serious, and they can interfere with rehabilitation, so it is important to take steps to prevent them."
Such steps, Gustafson says, include better education efforts for people taking care of stroke survivors, including family members and health care providers working in hospitals and nursing homes. Gustafson's research team has conducted intervention programs in Sweden designed to inform health care providers about reducing the risk of falls and preventing osteoporosis.
"Relatives play an important role here, because they are often the ones taking care of stroke patients," Gustafson says. "Education efforts are often aimed only at professional health care providers, but in this case that is not adequate. Educating family members about how to prevent falls is one of the most important steps we can take."