Alterations of bone mineral density of the femurs in hemiplegia

Abstract

We evaluated the bone mineral density (BMD) of the bilateral femurs in 112 patients with hemiplegia using dual-energy X-ray absorptiometry in order to elucidate the effect of disuse and immobilization. BMD of the paretic side was significantly reduced compared with that of the non-paretic side in hemiplegic patients (femoral neck 0.582 +/- 0.014 g/cm2 versus 0.623 +/- 0.014 g/cm2 and total femur 0.645 +/- 0.02 g/cm2 versus 0.702 +/- 0.017 g/cm2; mean +/- SEM, P < 0.01, respectively). Femoral BMD in both the paretic and nonparetic limb had significantly (P < 0.01) lower values than in age- and sex-matched controls, but the paretic side had a more significant reduction of BMD; femoral neck -20% versus -14% and total femur -24% versus -18%. In addition, patients with impaired activities of daily living (ADL), evaluated by a mobility score, had significantly decreased BMD ratios of paretic/nonparetic side than patients with improved ADL (femoral neck 91% versus 97%, P < 0.01 and total femur 89% versus 94%, P < 0.05). Our results indicated that BMD of both femurs of patients with hemiplegia was reduced, although the paretic side showed a greater BMD decrease. This decrease might be prevented or reduced by improvement of ADL.

Balance, falls, and bone health: Role of exercise in reducing fracture risk after stroke

“…First, BMD in the paretic limbs is consistently lower than in the nonparetic limbs (by ≤20%) [38,40,[50][51][52][53][54]. The magnitude of the side-to-side difference found in individuals with stroke is much higher than that found between the dominant and nondominant sides in nondisabled older individuals (<1.5%) [55], which suggests a pronounced effect of hemiparesis on bone loss.…”

Reduced hip bone mineral density is related to physical fitness and leg lean mass in ambulatory individuals with chronic stroke

“…Previous studies in stroke patients have reported 1.3-8.8% side-to-side difference in BMD at various sites in the legs [15,16,20,22,23,[50][51][52]. However, comparison with other studies is extremely difficult for several reasons.…”

“…However, comparison with other studies is extremely difficult for several reasons. First, these studies reported data from patients in different stages of stroke recovery such as acute [22], subacute [15,23,50,51], and chronic [15,50]. Second, many studies included subjects who were non-ambulatory [16,20,22,51,52].…”

“…Most studies in chronic stroke included relatively small samples of subjects and consisted of individuals with a wide range of capabilities [21][22][23]. No study has examined both proximal femur bone mineral and soft tissue composition in the lower extremities of community-dwelling, ambulatory individuals with chronic stroke.…”

Association of Physical Activity to the Risk of Obesity in Adults with Physical Disabilities

“…It has been shown that bone mineral density is altered in people who are wheelchair-bounded or paralyzed. 39,40 Therefore, DXA could minimize the measurement errors associated with the variations in bone mineral density between the reference body and individuals with physical disabilities. SKF, on the other hand, does not seem to be an appropriate technique for predicting %BF of adults with physical disabilities, including those with SCI.…”