Stroke, a major and increasing risk factor for femoral neck fracture

Background and Purpose-Patients with stroke have up to a 4-fold increased r isk of hip fracture because of their high incidence of falls and loss of bo ne mass in the paretic side, ie, hemiosteoporosis. The purpose of this stud y was to investigate the prevalence of previous stroke among patients with femoral neck fracture. Methods-The study included all 568 patients, a,aed greater than or equal to 65 years, who underwent surgery for femoral, neck fracture in 1980, 1983, 1987, 1993, and 1997 at the orthopedic clinic of Umea University Hospital, Umea, Sweden. Results-The prevalence of previous strokes ranged from 16.4% to 38.5% (P<0. 001); this finding is only partly explained by the increased incidence of s troke in the corresponding population, and there was no significant increas e in the overall incidence of femoral neck fracture. Fractures occurred 5.4 +/-6.4 years after stroke (median 2.9 years, range 0 to 33 years). In strok e patients with unilateral stroke and persisting paresis at the time of fra cture, 62.5% had their fracture on the paretic side (P=0.034). Survival was significantly reduced in patients with previous stroke (P<0.001). In patie nts previously independently mobile, 69.2% with no previous stroke and 38.1 % with previous stroke were still mobile at discharge from the orthopedic u nit (P<0.001). Conclusions-Attention must be focused on stroke as a major and increasing r isk factor for femoral neck fracture and also on the poor postfracture outc ome and reduced survival of these patients. Prevention of poststroke fractu res is necessary and is aimed at reducing the risk of poststroke fall and p reventing the development of hemiosteoporosis.