Fracture risk among stroke survivors according to post-stroke disability status and stroke type

Background Stroke survivors face physical and cognitive challenges, including impaired coordination and balance, which can lead to an increased dependency and a higher risk of falls. We aimed to investigate the impact of post-stroke disability status and stroke type on the risk of fracture at various sites compared to a matched comparison group. Method This retrospective cohort study used data from the Korean National Health Insurance System database (2010-2018) and included a total of 223,358 stroke patients and a 1:1 matched comparison group. Stroke survivors were grouped based on the presence and severity of their post-stroke disability and stroke type. The primary outcome was the incidence of newly diagnosed fracture. Cox proportional hazard regression analyses were used to calculate the hazard ratios of fractures after adjusting for potential confounders. Results Stroke survivors had an increased risk of overall fractures compared to the matched comparison group (adjusted hazard ratio [aHR] 1.40, 95% confidence interval [CI] 1.37-1.43). Specifically, the risk of hip fractures was even greater for stroke survivors: aHR 2.42, 95% CI 2.30-2.55. The risk of vertebral fractures (aHR 1.29, 95% CI 1.25-1.34) and other fractures (aHR 1.19, 95% CI 1.15-1.23) also was higher than that of the control group. The risk of hip fractures was highest among stroke survivors with severe post-stroke disability (aHR 4.82, 95% CI 4.28-5.42), while the risk of vertebral or other fractures was highest among those with mild post-stroke disability. There was no significant difference in fracture risk between hemorrhagic and ischemic stroke survivors when stratified by disability status. Conclusion Our findings showed an increased risk of subsequent fractures among stroke survivors, particularly those with post-stroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.