Evidence map›Paper›PMID 32689623›Full record

Observational studyJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2020

Association between post-stroke disability and 5-year hip-fracture risk: The Women's Health Initiative.

Carin A Northuis, Carolyn J Crandall, Karen L Margolis, Susan J Diem, Kristine E Ensrud, Kamakshi Lakshminarayan

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
2.2field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 19 citations in OpenAlex.

  1. Article
  2. Review
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
  8. Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2023
    Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Carin A NorthuisDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: north289@umn.edu.
Carolyn J CrandallDepartment of Medicine, University of California at Los Angeles, Los Angeles, CA. Electronic address: Ccrandall@mednet.ucla.edu.
Karen L MargolisHealthPartners Institute, Minneapolis, MN. Electronic address: karen.l.margolis@healthpartners.com.
Susan J DiemDivision of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN. Electronic address: sdiem@umn.edu.
Kristine E EnsrudDivision of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN. Electronic address: ensru001@umn.edu.
Kamakshi LakshminarayanDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: laksh004@umn.edu.
University of Minnesota · USHealthPartners · USUniversity of California, Los Angeles · US

Funding

Cardiovascular Disease Epidemiology &Prevention TrngT32HL007779 · NHLBI · UNIVERSITY OF MINNESOTA TWIN CITIES · PI PAMELA L. Lutsey, JAMES S PANKOW · 1994 to 2026
$9.3M
NHLBI NIH HHS HHSN268201600001CNHLBI NIH HHS HHSN268201600002CNHLBI NIH HHS HHSN268201600003CNHLBI NIH HHS HHSN268201600004CNHLBI NIH HHS HHSN268201600018CNHLBI NIH HHS T32 HL007779
6 · The paper itself

Abstract

backgroundHip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk.

methodsThe WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death.

resultsAverage age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant.

conclusionSevere disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.

Indexed as

Disability EvaluationGlasgow Outcome ScaleAgedAged, 80 and overAge FactorsFemaleHip FracturesHumansMiddle AgedOsteoporosis, PostmenopausalOsteoporotic FracturesPostmenopausePredictive Value of TestsPrognosisProspective StudiesRisk AssessmentGlasgow Outcome ScaleHip FractureStrokeWomen

Identifiers

PMID32689623
PMCPMC7394038
OpenAlexW3035264715

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.