J Korean Med Sci.  2019 Jun;34(22):e164. 10.3346/jkms.2019.34.e164.

The Epidemiology of Fracture in Patients with Acute Ischemic Stroke in Korea

Affiliations
  • 1Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 2Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. braindoc@snu.ac.kr
  • 3Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
  • 4Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 5Department of Neurology, Seoul Medical Center, Seoul, Korea.
  • 6Department of Neurology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea.
  • 7Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 8Department of Neurology, Dong-A University Hospital, Busan, Korea.
  • 9Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
  • 10Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.
  • 11Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 12Department of Neurology, Dongguk University Ilsan Hopital, Goyang, Korea.
  • 13Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
  • 14Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
  • 15Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.
  • 16Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
  • 17Clinical Research Center, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population.
METHODS
Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures.
RESULTS
Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17–1.30), women (HR, 1.74; 95% CI, 1.54–1.97), previous fracture (HR, 1.72; 95% CI, 1.54–1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27–1.63) were independent risk factors of post-stroke fracture.
CONCLUSION
The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.

Keyword

Stroke; Fracture; Incidence
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