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.
Bone loss also contributes to the higher risk of fracture among people hospitalized for stroke. Bone loss can be as great as 2% per week during prolonged bed rest, which may occur during poststroke hospitalization, and brittle bones increase the risk of fracture during a fall.
So what's a person to do?
A lot of times people who have had a stroke refuse to use a cane or a walker, says Gilroy.
"You need to use mechanical aids to help stabilize you," Gilroy says. "If you don't do that you will fall, and you have a high risk of fracture."
Gilroy also advises caregivers to insist that the patients use walking aids. "Don't take no for an answer," he says.
"Modern walkers are light years away from old-fashioned walkers," he says, pointing out that the newer models are lightweight and come with handlebars and brakes.
Because stroke patients have balance deficits after the stroke, "the patient needs to be under supervision and/or guarded appropriately so he or she can be protected, especially outside or on wet surfaces, when falls are more likely," says Jim Pye, a senior physical therapist at Temple University Medical Center in Philadelphia.
Pick up throw rugs and bathroom mats that are likely to promote slipping, he suggests.
And encourage the patient to "use your bones more," Pye says.
Generally, stroke patients don't walk as much or maintain the active lifestyle they had prior to the stroke, "so their bones get weaker. And they are at a greater risk of fractures if and when they fall," Pye tells WebMD.
"Work with your physical therapist to learn exercises that build strength and improve balance and stability," he says. "The more you use your bones, the stronger you get."