Osteoporosis in Hemiplegia

Abstract

Abstract:Osteoporosis in Hemiplegia • Localized osteoporosis in 25 long-term stroke patients was evaluated by means of measuring the combined cortical thickness in the humerus, radius and third metacarpal bones of both involved and noninvolved upper extremities. The combined cortical thickness was found to be consistently smaller on the involved side. Since the factors of weight bearing and calcium homeostasis were eliminated or controlled in this study, the authors were able to focus on the role of muscle pull as manifested by voluntary muscle function and spasticity in relation to the degree of cortical thinning. A smaller degree of cortical thinning was associated with better voluntary muscle function, but the relationship of spasticity to preservation of cortical thickness was not clear cut. The applicability of these techniques to the study of factors affecting localized osteoporosis is discussed. ADDITIONAL KEY WORDS cerebral infarctioncombined cortical thickness hemiparesis physical therapy• Considering the rapidly growing population of elderly individuals, the osteoporotic process takes on increasing significance for the clinician. The decreased bone density and increased fragility associated with osteoporosis leads to a corresponding increase in the incidence of fractures, skeletal pain and interference with mobility. These sequelae have obvious psychological, sociological and economical implications.Difficulty in dealing with this problem prophylactically or therapeutically arises because (1) the etiological factors and their interrelationship are not clearly understood, and (2) simple, readily accessible and universally applicable techniques of assessment are not available or widely known. Osteoporosis has been described as a decrease in a total

Fractures after Stroke

“…Stroke patients fall mainly towards their paretic side due to balance problems and detoriation in neuromuscular response, which leads to a reduced ability to protect themselves when they fall [23][24][25]. Another contributing risk factor may be the development of disuse osteoporosis on the paretic side [1][2][3]8,9,11,26,27].…”

“…Previous cross-sectional studies have indicated that fractures are a common and serious complication after stroke [1][2][3][4] and they usually affect the paretic side. This might be caused by the high incidence of accidental falls in stroke patients [5][6][7] and by the development of osteoporosis, due to immobilization and other contributing factors [1,2,[8][9][10][11].…”

Tibial changes in experimental disuse osteoporosis in the monkey

“…Losses of cortical bone in man are seen in immobilization [1][2][3] and in senile osteoporosis [4,5]. Studies in our laboratory have also shown characteristic losses of tibial cortical bone in restrained hypodynamic monkeys [6].…”

Bone loss and fractures in multiple sclerosis: focus on epidemiologic and physiopathological features

“…At the same time excessive spasticity may cause fractures through uncontrolled limb movements, ie, in a wheelchair. Therefore, spasticity probably has two effects on bone: a low grade of spasticity benefits, while a high spasticity grade could be detrimental 21,22. Studies in spinal cord-injured (SCI) subjects have reported controversial results for the effect of spasticity on BMD, ie, either less reduction of BMD in the spastic SCI compared with flaccid SCI subjects, or spasticity may be protective against bone loss in SCI, but without any preserving effect in the tibia 23.…”