Fracture risk high after stroke in US veterans

By Michelle Rizzo

NEW YORK (Reuters Health) - Veterans who have had a stroke have a high risk of suffering a fracture over the next few years, according to a study in the Journal of the American Geriatric Society.

Dr. Heather E. Whitson, of Duke University Medical Center, Durham, North Carolina, and colleagues examined the fracture rate among stroke patients in the Veterans Affairs hospital system. The team looked at data on 1073 veterans in the VA Acute Stroke (VASt) cohort and 6578 veterans in the Integrated Stroke Outcomes Database (ISOD).

A total of 51 patients in the VASt cohort and 244 in the ISOD cohort had at least one fracture within 2 years of stroke onset. The researchers calculate that the annual fracture rate in these two VA cohorts was two to three times higher than seen in some studies of men without stroke.

The highest risk of fracture was found in VA stroke patients with moderate, rather than mild or severe, functional impairment.

"At first pass, it is surprising to find that patients with moderate functional impairment were actually at higher risk of fracture than severely impaired patients." Whitson said in an interview with Reuters Health.

"This may occur because stroke patients with severe impairments are less ambulatory and therefore less likely to fall and fracture," she suggested. "The increased independence and mobility of moderately impaired patients may render them more vulnerable to future injury."

Whitson noted that "since many fractures are preventable, (we) hope this research will lead to strategies that successfully lower the fracture risk in stroke patients."

"The accumulation of disease and morbidities is a well-recognized problem in older patients, and it can lead to bad outcomes like disability and frailty," the investigator said. "As the population ages, it is important to learn more about how one ailment can lead to a second ailment, so that a dangerous accumulation of diseases can be avoided."

SOURCE: Journal of the American Geriatric Society, July 2006.