Osteoporosis after Stroke: A Review of the Causes and Potential Treatments

Carda, Stefano; Cisari, Carlo; Invernizzi, Marco; Bevilacqua, Maurizio

doi:10.1159/000226578

Cited by 86 publications

(80 citation statements)

References 149 publications

(141 reference statements)

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“…1 Stroke may also be associated with declines in bone mineral density and an increased risk of falls, both factors that can predispose to subsequent low-trauma (fragility) fractures. [2][3][4][5][6][7][8][9][10] Previous studies have suggested an up to 4-fold increase in the risk of fractures in those with stroke compared to healthy controls. [7][8][9][10][11][12][13] However, it is not known how much of this fracture risk is due to the stroke itself rather than differences in other baseline factors such as age and comorbidity.…”

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confidence: 99%

Risk of fractures after stroke

et al. 2017

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Objective: To determine the risk of fractures after stroke.Methods: Using the Ontario Stroke Registry, we identified a population-based sample of consecutive patients seen in the emergency department or hospitalized with stroke (n 5 23,751) or TIA (n 5 11,240) at any of 11 stroke centers in Ontario, Canada, and discharged alive between July 1, 2003, and March 31, 2012. We compared the risk of low-trauma fractures in patients with stroke vs those with TIA using propensity score methods to adjust for differences in baseline factors. Secondary analyses compared fracture risk poststroke with that in age-/sex-matched controls without stroke or TIA (n 5 23,751) identified from the Ontario Registered Persons Database. Results:The 2-year rate of fracture was 5.7% in those with stroke compared to 4.8% in those with TIA (adjusted cause-specific hazard ratio [aHR] for those with stroke vs TIA 1.32; 95% confidence interval [CI] 1.19-1.46) and 4.1% in age-/sex-matched controls (aHR for those with stroke vs controls 1.47; 95% CI 1.35-1.60). In the cohort with stroke, factors associated with fractures were older age, female sex, moderate stroke severity, prior fractures or falls, and preexisting osteoporosis, rheumatoid arthritis, hyperparathyroidism, and atrial fibrillation.Conclusions: Stroke is associated with an increased risk of low-trauma fractures. Individuals with stroke and additional risk factors for fractures may benefit from targeted screening for low bone mineral density and initiation of treatment for fracture prevention. Stroke is a leading cause of adult disability, and up to two-thirds of stroke survivors have limitations in mobility.1 Stroke may also be associated with declines in bone mineral density and an increased risk of falls, both factors that can predispose to subsequent low-trauma (fragility) fractures. 2-10Previous studies have suggested an up to 4-fold increase in the risk of fractures in those with stroke compared to healthy controls. 7-13 However, it is not known how much of this fracture risk is due to the stroke itself rather than differences in other baseline factors such as age and comorbidity. A better understanding of both the fracture risk attributable to stroke and the specific factors associated with such fractures would allow for improved screening, prevention, and treatment of osteoporosis and fractures following stroke.We used data from a clinical stroke registry in Ontario, Canada, linked with administrative data, to evaluate the risk of fractures in patients with acute stroke compared to those with TIA. In order to focus on the contribution of stroke (rather than baseline comorbid conditions) to fracture risk, we selected patients with TIA as our reference population, as they are anticipated From the Institute for Clinical Evaluative Sciences

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Risk of fractures after stroke

et al. 2017

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“…İnme sonrası ortaya çıkan immobilizasyonun erken dönemde kemikte rezorbsiyon odakları oluş-ması, osteoblastik stimulusun azalması ve osteoklastik aktivitenin artması ile beraber hızlı kemik kaybına yol açtığı belirtilmektedir (23). Kemik mineral yoğunluğu kaybı, alt ekstremite için ayağa kalkma ile beraber vücut ağırlığının etkisi ile düzelmeye başlar-ken, üst ekstremitede parezi devam ettiği için KMY kaybı yoğun bir şekilde devam etmektedir.…”

Section: Brunnstrom Frekans Dağılımıunclassified

“…Bizim de çalışmamızda saptadığımız, hastalarımızın düşük FBÖ skorları ile etkilenen taraf el KMY değerleri arasındaki korelasyon bu bulguları desteklemektedir. Fonksiyonel bağımsız-lık düzeyi kötü olan hastaların zaman içerisinde KMY kaybına uğradıkları bildirilmiştir (23). Ayrıca yapılan çalışmalarda mobilitesi kötü olan yani fonksiyonel bağımsızlık düzeyi kötü olan hastalarda düşme riskinin de fazla olduğu bildirilmiştir.…”

Section: Brunnstrom Frekans Dağılımıunclassified

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Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

Öncü¹,

Begoglu²,

Durlanik³

et al. 2014

Turk J Phys Med Rehab

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Objective: The aim of this study was to evaluate the hand bone mineral density (BMD) measurements and to assess the relationship between demographic and clinical parameters. Material and Methods:The study included 119 (46 women, 63 men) hemiplegic patients. Brunnstrom stage of the upper extremity and Modified Ashworth scale was used, for the evaluation of motor function and spasticity. The level of functional independence in patients were evaluated with the functional independence measure (FIM). Hand dual energy x-ray absorptiometry (DEXA; Lunar Prodigy Advance, Lunar Corp., USA) for the assessment of bone mineral density of both hands were used. Results: In the entire group (p<0.01) and women (p<0.01) and in males (p<0.05) the paretic hand BMD values were significantly lower than the non-paretic side. Non-paretic hand BMD in women, were significantly lower than men (p<0.05). BMD on the hemiplegic hand was correlated with the hand and upper extremity spasticity severity (p<0.05), Brunnstrom stage (p<0.01), age in women (p<0.05) and FIM score (p<0.01). There were no statistically significant correlation between hand BMD and disease duration. Regression analysis revealed that the strongest predictors of BMD of the hemiplegic side were Brunnstrom stage (OR=4.701, p=0.001), FIM (OR=4.022, p=0.001) and women age (OR=1.220, p=0.050), respectively. Conclusion: To avoid an increase in fractures and associated morbidity due to a decrease in BMD of the upper extremity; the improvement in motor paresis and spasticity and functional independence, should take place in neurological rehabilitation program. Key Words: Bone mineral density, hemiplegic hand, functional activity Özet Amaç: Bu çalışmadaki amacımız, inmeli hastalarda paretik ve sağlam üst ekstremitede el kemik mineral yoğunluğunu (KMY) değerlendirmek ve KMY ölçümleri ile demografik ve klinik parametreler arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Çalışmaya 119 (56 kadın, 63 erkek) tek taraflı inme hastası alınmıştır. Üst ekstremitenin ve elin motor değerlendirmesinde Brunnstrom evrelemesi, spastisite değerlendirmesinde Modifiye Ashworth skalası kullanılmıştır. Hastaların fonksiyonel bağımsızlık düzeyi fonksiyonel bağımsızlık ölçeği (FBÖ) ile değerlendirilmiştir. Her iki el KMY ölçümlerinin değerlendirilmesinde Dual-Enerji X-ray absorbsiyometri (DEXA; Lunar Prodigy Advance, Lunar Corp., ABD) kullanılmıştır. Bulgular: Grubun tamamında (p<0,01), kadınlarda (p<0,01) ve erkeklerde (p<0,05) paretik taraftaki el KMY değerleri sağlam taraftan istatistiksel olarak anlamlı derecede daha düşüktü. Sağlam tarafta KMY değerleri kadınlarda, erkeklerden istatistiksel olarak anlamlı derecede daha düşüktü (p<0,05). Hemiplejik taraftaki el KMY değerleri ile üst ekstremite ve el spastisite şiddeti (p<0,05), Brunnstrom evresi (p<0,01), kadınlarda yaş (p<0,05) ve FBÖ skoru (p<0,01) arasında istatistiksel olarak anlamlı ilişki saptanırken; hastalık süresi arasında anlamlı ilişki saptanmadı. Hemiplejik taraftaki el KMY değerlerinin en güçlü belirleyicileri regresyon ana...

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“…In addition, poor nutrition (e.g., vitamin D deficiency) and pharmacological agents commonly used after stroke, such as anticoagulants, have been associated with bone loss. 22,23 Exercise is also important for the prevention of secondary complications related to cardiovascular related events (e.g., a heart attack, a second stroke). Cardiovascular disease is the leading cause of death in chronic stroke.…”

Section: Exercise and Motor Functionmentioning

confidence: 99%

Fitness and Mobility Exercise Program for Stroke

Eng

2010

Topics in Geriatric Rehabilitation

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Given the potential of exercise to positively influence so many physical and psychosocial domains, the Fitness and Mobility Exercise (FAME) Program was developed to address the multiple impairments arising from the chronic health condition of stroke. We present the details of this exercise program and the evidence which has shown that the FAME Program can improve motor function (muscle strength, balance, walking), cardiovascular fitness, bone density, executive functions and memory. The FAME Program can help to improve the physical and cognitive abilities of people living with a stroke and reduce the risk of secondary complications such as falls, fractures and heart disease. Keywords stroke; rehabilitation; exercise; cognition; physical activity; cardiovascular fitness; walking Stroke is a leading cause of neurological disability in older adults. 1 At age 55, there is a lifetime risk of stroke of 1 in 5 in women and 1 in 6 for men. 2 It is expected there will be an increase in the number of people living with stroke because of the aging population, an increase in diabetes and obesity (all risk factors for stroke), as well as better acute management leading to a reduction in deaths. 1 The risk factors for stroke include age, obesity, hypertension, elevated blood cholesterol, carotid stenosis, atrial fibrillation, cigarette smoking, diabetes mellitus and heart disease. 3 Thus, it is likely that individuals prior to having a stroke are not particularly active given existing health conditions. The stroke event then causes a number of additional functional limitations which include muscle weakness, pain, spasticity, cognitive dysfunction and poor balance. The burden of these impairments, combined with a further reduction in activity can then lead to a vicious cycle of decline in function and disability status. 4 This article will review selected impairments and functions affected by a stroke and the potential effects of a specific exercise program (Fitness and Mobility Exercise Program) on health domains.

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Osteoporosis after Stroke: A Review of the Causes and Potential Treatments

Cited by 86 publications

References 149 publications

Risk of fractures after stroke

Risk of fractures after stroke

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

Fitness and Mobility Exercise Program for Stroke

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