Abstract P402: Association Between Post-stroke Disability and 5-year Hip-fracture Risk: the Women’s Health Initiative
Bibliographic record
Abstract
Background: Hip fractures are a significant post-stroke complication. While studies have shown an increased incidence of hip fractures post-stroke, the relationship between stroke-related disability and hip fracture rates are not well characterized. Herein, we examine factors associated with hip fracture risk after stroke using the Women’s Health Initiative (WHI) data. Methods: The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. In the WHI, stroke cases were initially self-reported and then confirmed by a neurologist adjudication using medical records and a manual. Hip fracture cases were self-reported and then radiologically confirmed by physician adjudication. We included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Score (GOS) of 1-3 (good recovery, moderately disabled, severely disabled) and survived at least one week after stroke (n=4,640). Survival free from any radiologically-confirmed hip fracture post-stroke was estimated and compared by GOS status. Secondary analysis examined the post-stroke hip fracture risk while accounting for the competing risk of death. Results: There were 124 hip fractures. Average age of stroke was 74.6 ± 7.2 years. Mean follow-up time was 3.1±1.8 years. Hip fractures by GOS status represented 2.4% (45/1872), 2.5% (34/1366), and 3.5% (45/1278) among good recovery, moderately disabled, and severely disabled. In the competing risk model, 23.3% (1079/4640) of the participants died before the end of follow-up or the occurrence of a hip fracture. Severely disabled (HR: 2.1 (95% CI: 1.3, 3.2), p=0.001) status, but not moderately disabled (HR: 1.1 (95% CI: 0.7, 1.7) p=0.8), was significantly associated with an increase in risk of hip fracture compared to good recovery status. This association was attenuated and not significant for moderately disabled (HR: 1.1 (95%CI: 0.7, 1.7), p=0.8) and severely disabled (HR 1.5 (95%CI: 1.0, 2.3), p=0.06) status when accounting for mortality after stroke. High Hip Fracture Risk Assessment Tool (FRAX) risk (without bone density information), being Caucasian, and increasing age were associated with an increased post stroke hip fracture risk. When accounting for mortality after stroke, higher FRAX-predicted hip fracture risk and race/ethnicity remained significant. The association between age and hip fracture was attenuated and not significant after accounting for post-stroke mortality. Conclusion: Among stroke survivors, severely disabled status and FRAX-predicted hip fracture risk were associated with a higher risk of subsequent radiologically confirmed hip fracture, but only the FRAX-predicted hip fracture risk association remained significant when considering the competing risk of mortality after stroke. Interventions to reduce fracture risk after stroke should be evaluated in clinical trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".