Non-pharmacological interventions for bone health after stroke: A systematic review

Abstract

Objective To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients. Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021. Methods A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis. Results Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported. Conclusion There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

Regulation of Bone by Mechanical Loading, Sex Hormones, and Nerves: Integration of Such Regulatory Complexity and Implications for Bone Loss during Space Flight and Post-Menopausal Osteoporosis

“…The causes of the bone loss are not well characterized but may be due to inactivity, vitamin D deficiency, or secondary effects of the stroke [104,108], but direct effects of the loss of neural regulation have not been discussed in any detail. Interestingly, attempts to prevent or reverse the post-stroke bone loss using drug interventions (discussed in [108]), as well as non-pharmacological interventions, such as exercise [109][110][111], have been reported. These approaches have been partially effective, but some localized responses have been noted and drug variation in responsiveness.…”

The pathogenesis of post-stroke osteoporosis and the role oxidative stress plays in its development

“…However, the impact that amino acid supplementation has on bone properties was not measured. Therefore, in order to create the best prevention and treatment strategy for bone loss and osteoporosis after stroke, it is advisable to adopt an array of interventions, including individualized physical and drug therapy, ample intake of protein, calcium and vitamin D, rather than relying on a single approach or treatment ( 95 ).…”

Impact of Osteoporosis Pharmacotherapy on Functional Outcomes after Ischemic Stroke

“…That is not to say that less importance is being given to osteoporosis; rather, this lack of recommendation could be explained by a scarcity of studies investigating the prognostic significance of osteoporosis as well as limited studies on osteoporosis in stroke patients [9]. A recent study evaluated whether non-pharmacological intervention could improve bone health after stroke [10]. However, no study has investigated the impact of OPT on stroke outcomes after ischemic stroke.…”