Bone mineral density in patients with stroke

Abstract

The objectives of this study were to investigate the development and pathogenesis of osteoporosis in stroke in-patients, to compare the bone mineral density (BMD) of the paretic and non-paretic sides, to study longitudinal changes during the period on the rehabilitation ward and to relate BMD to demographic, impairment and disability variables. Participants were 32 first-stroke in-patients (19 men), with an average age of 62.4 +/- 8.1 years. Demographic and clinical characteristics were documented. The BMD of lumbar spine, bilateral distal radius and femoral neck were measured and compared at admission and discharge. The associations between bone loss and age, sex, time since stroke, Brunnstrom motor recovery scores and functional independence measure motor (mFIM) scores were assessed. The mean percentage differences in BMD between paretic and non-paretic arms at discharge were 12% (P < 0.001) and 3.5% (P < 0.05), respectively, and between paretic and non-paretic legs were 5% (P < 0.01) and 2% (P < 0.05), respectively. There was a statistically significant correlation between BMD loss and Brunnstrom stage (r = -0.41) and mFIM score at admission (r = -0.42). In conclusion, patients with hemiparesis due to stroke are at increased risk of developing osteoporosis on the paretic side. Higher motor impairment and functional dependency at admission increases the risk. New strategies are needed for stroke patients to prevent further decreases in BMD and reduce the risk of fractures.

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.…”

“…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]. Third, BMD was measured at different sites in the lower extremity in different studies such as femoral neck [15,20,51,52], trochanter [20], proximal femur [16], total femur [16], first metatarsus [21] and whole leg [6,50].…”

“…Second, many studies included subjects who were non-ambulatory [16,20,22,51,52]. Third, BMD was measured at different sites in the lower extremity in different studies such as femoral neck [15,20,51,52], trochanter [20], proximal femur [16], total femur [16], first metatarsus [21] and whole leg [6,50]. This is the first study to examine total proximal femur BMC and BMD in community-dwelling, independent ambulators with chronic stroke.…”

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

“…Following a stroke, individuals can have a multitude of impairments that result in compromised functional status, low physical activity, reduced use of the paretic arm and leg, and consequently bone loss overall that is greater on the paretic side. In persons with stroke, BMD on the paretic side has been correlated with muscle strength [38][39], muscle atrophy [38,40], degree of motor recovery [41][42][43][44], cardiovascular fitness [40], ability to perform functional activities [42,[44][45], walking ability [46], weight-bearing ability [47], and amount of skeletal loading [48]. The nonparetic side may also sustain a certain degree of bone loss that is less pronounced when compared with the paretic side [46][47]49].…”

Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

“…Of these fractures, 27-36% occur in the upper extremity [1,3]. Decreased use of the paretic upper extremity due to various impairments such as muscle weakness, spasticity and reduced motor skills may lead to secondary complications, such as bone loss and muscle atrophy [4][5][6][7][8][9]. In addition, individuals with stroke also have a higher risk of falls than the age-matched population [10].…”