Presented at the Presidential Poster Session, 2005 Annual Meeting of the American Geriatrics Society.
Adding Injury to Insult: Fracture Risk After Stroke in Veterans
Article first published online: 10 MAY 2006
Journal of the American Geriatrics Society
Volume 54, Issue 7, pages 1082–1088, July 2006
How to Cite
Whitson, H. E., Pieper, C. F., Sanders, L., Horner, R. D., Duncan, P. W. and Lyles, K. W. (2006), Adding Injury to Insult: Fracture Risk After Stroke in Veterans. Journal of the American Geriatrics Society, 54: 1082–1088. doi: 10.1111/j.1532-5415.2006.00769.x
- Issue published online: 6 JUL 2006
- Article first published online: 10 MAY 2006
OBJECTIVES: To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts.
DESIGN: Secondary analyses of two prospective cohorts.
SETTING: Veterans Affairs (VA) Medical Centers.
PARTICIPANTS: The VA Acute Stroke (VASt) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997. The Integrated Stroke Outcomes Database (ISOD) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002.
MEASUREMENTS: Fractures detected using International Classification of Diseases, 9th Revision, codes in the VA computerized patient record system; baseline patient characteristics and stroke features; Functional Independence Measures scores in ISOD.
RESULTS: Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1% and 4.7%, respectively. Longer hospitalizations for stroke (P=.06) and new motor or sensory impairment (P=.09) showed trends toward greater risk in the VASt cohort. Female sex (P <.001), cognitive impairment (P=.01), and nonblack race (P=.04) were associated with higher fracture risk in the ISOD. Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment.
CONCLUSION: Veterans who suffer a stroke are at high risk of subsequent fracture, which can lead to further disability. Women, nonblacks, and those with intermediate functional impairment were at particularly high risk of fracture. Future study should investigate therapies to decrease fracture risk in stroke patients.