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Stroke and osteoporosis: a Taiwan cohort study
  1. Li Zhang1,
  2. Zi-Hao Zhang2,3,
  3. Qing-Rui Wang4,
  4. Ying-Ju Su5,
  5. Ying-Yi Lu6,7,8,
  6. Cong-Liang Zhang9,
  7. Hung-Pei Tsai10,11,
  8. Chieh-Hsin Wu10,12
  1. 1Department of Neurosurgery, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, P.R. China
  2. 2Department of Neurosurgery, The No.7 People’s Hospital of Hebei Province, Dingzhou, Hebei, P.R. China
  3. 3Department of Neurosurgery, the Affiliated Second Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, P.R. China
  4. 4Department of Neurosurgery, Qinghe County Central Hospital of Hebei Province, Qinghe, Hebei, P.R. China
  5. 5Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  6. 6Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  7. 7Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
  8. 8Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  9. 9Department of Cardiology, Hebei Quyang Renji Hospital, Quyang, Hebei, P.R. China
  10. 10Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  11. 11Division of Neurosurgery,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  12. 12Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  1. Correspondence to Dr Chieh-Hsin Wu, Kaohsiung 80756, Taiwan; wujoeys{at}


Background Osteoporosis and stroke are major health problems that have potentially overlapping pathophysiological mechanisms. The aim of this study was to estimate osteoporosis risk in Taiwan patientswho had a stroke.

Method This study retrieved data contained in the Taiwan National Health Insurance Research Database for a population-based sample of consecutive patients either hospitalised for stroke or treated for stroke on an outpatient basis. A total of 7550 newly diagnosed patientswho had a stroke were enrolled during 1996–2010. Osteoporosis risk in these patients was then compared with a matched group of patients who had not had a stroke randomly selected from the database at a ratio of 1:4 (n=30 200). The relationship between stroke history and osteoporosis risk was estimated with Cox proportional hazard regression models.

Results During the follow-up period, osteoporosis developed in 1537 patients who had a stroke and in 5830 patients who had not had a stroke. The incidence of osteoporosis for cohorts with and without stroke was 32.97 and 14.28 per 1000 person-years, respectively. After controlling for covariates, the overall risk of osteoporosis was 1.82-fold higher in the stroke group than in the non-stroke group. The relative osteoporosis risk contributed by stroke had apparently greater impact among male gender and younger age groups.

Conclusion History of stroke is a risk factor for osteoporosis in Taiwan. Much attention to stroke-targeted treatment modalities might minimise adverse outcomes of osteoporosis.

  • osteoporosis
  • cohort study
  • stroke

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  • Contributors Z-HZ and LZ were equal contributors in this study. Y-JS and Q-RW were equal contributors in this study. The authors’ individual contributions are outlined as follows. Substantial contributions to conception and design: LZ, Q-RW, Z-HZ, Y-JS, Y-YL, C-LZ and C-HW. Drafting and revising the article critically for important intellectual content: Q-RW, LZ, Y-JS, Z-HZ, H-PT and C-HW. Final approval of the version to be published: Z-HZ, LZ and C-HW.

  • Funding This work was supported by KMUH105-5M17, KMUH106-6T09, KMUH108-8M23 and KMU-Q108029 from Kaohsiung Medical University Hospital.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-EXEMPT (I)−20150032).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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