Characteristics of Fall-Related Fractures in Older Adults with Cerebrovascular Disease: A Cross-Sectional Study

Figures & data

Table 1 The Distribution of Place and Time of Fracture Occurrence, and Injury Mechanism

Variables	Cases	Percentage (%)
Place
Indoor
Living room	194	25.3
Bathroom	145	18.9
Bedroom	121	15.8
Kitchen	8	1.0
Outdoor (community court or on the way to or from outside)	281	36.6
Other places (public sites including market, park, hospital; staircase; and sports field)	19	2.5
Time
Dawn (00:00–6:00)	55	7.2
Morning (6:00–12:00)	210	27.3
Afternoon (12:00–18:00)	333	43.4
Evening (18:00–24:00)	170	22.1
Injury mechanism
Instability or weakness	265	34.5
Sudden change in body positions	203	26.4
Slips	148	19.3
Trips	58	7.6
Dizziness	19	2.5
Stepping on an empty step	18	2.4
Others	57	7.4

Table 2 The Distribution of Fracture Based on Different Locations

Fracture Location	Cases	Percentage (%)
Humeral fracture
Proximal	48	5.9
Shaft	3	0.4
Distal	11	1.3
Ulna and radius fracture
Proximal	6	1.2
Shaft	4	0.5
Distal	11	1.3
Femoral fracture
Proximal
Femur neck fracture	242	29.7
Femur intertrochanteric fracture	354	43.4
Shaft	13	1.6
Distal	17	2.1
Tibia and fibula
Proximal	6	0.7
Shaft	2	0.2
Distal	12	1.5
Scapular fracture	3	0.4
Clavicle fracture	9	1.1
Hand fracture	1	0.1
Foot fracture	4	0.5
Pelvic/ acetabular fracture	19	2.3
Patella fracture	18	2.2
Vertebra fracture	32	3.9

Table 3 The Detailed Distribution of Age, Age Group, Type of Cerebrovascular Disease, Comorbidities and Complications Stratified by Gender

Variables	Total	Male	Female	P value
Number of patients, n (%)	768 (100)	253 (32.9)	515 (61.7)
Age, years	78.3±7.7	77.9±7.8	78.6±7.7	0.276
Age, years (range)	65–110	65–110	65–106
Age groups, n (%)				0.728
65–69	121 (15.8)	44 (36.4)	77 (63.6)
70–74	141 (18.4)	50 (35.5)	91 (64.5)
75–79	152 (19.8)	44 (28.9)	108 (71.1)
80–84	180 (23.4)	62 (34.4)	118 (65.6)
85–89	124 (16.1)	38 (30.6)	86 (69.4)
≥ 90	50 (6.5)	15 (30.0)	35 (70.0)
Type of cerebrovascular disease, n (%)
Ischemic cerebrovascular disease
Ischemic stroke	541 (70.4)	174 (22.7)	367 (47.8)	<0.001*
Transient ischemic attack	23 (3.0)	6 (0.8)	17 (2.2)	0.022*
Hemorrhagic cerebrovascular disease
Cerebral hemorrhage	55 (7.2)	26 (3.4)	29 (3.8)	0.686
Cerebrovascular disease without acute focal neurological deficit
Asymptomatic cerebral infarction	149 (19.4)	47 (6.1)	102 (13.3)	<0.001*
Ischemic stroke combining with cerebral hemorrhage	15 (2.0)	8 (1.0)	7 (0.9)	0.796
Comorbidities, n (%)
Hypertension	483 (62.9)	143 (18.6)	340 (44.3)	<0.001*
Coronary heart disease	258 (33.6)	78 (10.2)	180 (23.4)	<0.001*
Diabetes	234 (30.5)	69 (9.0)	165 (21.5)	<0.001*
Prior fragility fracture	119 (15.5)	35 (4.6)	84 (10.9)	<0.001*
Arrhythmia	46 (6.0)	23 (3.0)	23 (3.0)	1.000
Respiratory disease	51 (6.6)	27 (3.5)	24 (3.1)	0.674
Knee osteoarthritis	44 (5.7)	14 (1.8)	30 (3.9)	0.016*
Malignant neoplasm	27 (3.5)	8 (1.0)	19 (2.5)	0.034*
Chronic kidney disease	18 (2.3)	4 (0.5)	14 (1.8)	0.018*
Rheumatic immune disease	11 (1.4)	3 (0.4)	8 (1.0)	0.132
Parkinson’s disease	9 (1.2)	3 (0.4)	6 (0.8)	0.317
Neuropsychiatric disorders	6 (0.8)	1 (0.1)	5 (0.7)	0.102
Perioperative complications, n (%)
Anemia	304 (39.6)	89 (11.6)	215 (28.0)	0.014*
Hypoproteinemia	304 (39.6)	88 (11.5)	216 (28.1)	<0.001*
Deep vein thrombosis	289 (37.6)	89 (11.6)	200 (26.0)	<0.001*
Electrolyte disorders	265 (34.5)	83 (10.8)	182 (23.7)	<0.001*
Perioperative hyperglycemia	226 (29.4)	78 (10.2)	148 (19.3)	<0.001*
Cardiac complications	215 (28.0)	61 (7.9)	154 (20.1)	<0.001*
Pulmonary complications	74 (9.6)	34 (4.4)	40 (5.2)	0.485

Notes: Plus–minus values are means±SD. In number of patients, age groups, type of cerebrovascular disease, comorbidities, and perioperative complications, values are presented as the number (%). *P < 0.05, statistical significance.

Figure 1 The detailed distribution of fracture stratified by age and gender.

Table 4 The Association of Complications with Gender, Age, Type of Cerebrovascular Disease, Fracture Location, Comorbidities, and Number of Comorbidities

Variables	Total	Complications		P value
		Yes	No
Gender				0.501
Male	253	191 (75.5)	62 (24.5)
Female	515	400 (77.7)	115 (22.3)
Age				<0.001*
< 80	414	298 (72.0)	116 (28.0)
≥ 80	354	293 (82.8)	61 (17.2)
Type of cerebrovascular disease				0.077*
Ischemic stroke	541	409 (75.6)	132 (24.4)
Transient ischemic attack	23	17 (73.9)	6 (26.1)
Asymptomatic cerebral infarction	149	127 (85.2)	22 (14.8)
Cerebral hemorrhage	40	28 (70.0)	12 (30.0)
Ischemic stroke combining with cerebral hemorrhage	15	10 (66.7)	5 (33.3)
Fracture location				<0.001*
Upper limb fracture	59	33 (55.9)	26 (44.1)
Lower limb fracture	633	505 (79.8)	128 (20.2)
Trunk fracture	31	20 (64.5)	11 (35.5)
Multiple fracture	45	33 (73.3)	12 (26.7)
Comorbidities
Hypertension	483	373 (77.2)	110 (22.8)	0.815
Coronary heart disease	258	205 (79.5)	53 (20.5%)	0.241
Diabetes	234	174 (74.4)	60 (25.6)	0.258
Prior fragility fracture	122	102 (83.6)	20 (16.4)	0.057*
Arrhythmia	56	45 (80.4)	11 (19.6)	0.530
Respiratory disease	51	45 (88.2)	6 (11.8)	0.048*
Knee osteoarthritis	44	37 (77.3)	7 (22.7)	0.247
Number of comorbidities				0.042*
< 3	590	444 (75.3)	146 (24.7)
≥ 3	178	147 (82.6)	31 (17.4)

Notes: Values are presented as the number (%). *P < 0.1, statistical significance.

Figure 2 Multivariate logistic regression analysis result of covariates odds ratios (OR) for complications. The adjusted OR provides the association of covariates and complications after adjusting for variables with a p-value < 0.1 in the unadjusted model. Squares represent ORs and lines represent 95% confidence intervals. The ORs are on logarithmic scale.

Abbreviations: TIA, Transient ischemic attack; ACI, Asymptomatic cerebral infarction; CH, Cerebral hemorrhage; ISCCH, Ischemic stroke combining with cerebral hemorrhage; ULF, Upper limb fracture; LLF, Lower limb fracture; MF, Multiple fracture; PFF, Prior fragility fracture; RD, Respiratory disease.