Osteoporosis in hemiplegic stroke patients as studied with dual-energy x-ray absorptiometry

Liu, Meigen; Tsuji, Takao; Higuchi, Yoshiko; Domen, Kazuhisa; Tsujiuchi, Kazuhito; Chino, Naoichi

doi:10.1016/s0003-9993(99)90019-9

Cited by 52 publications

(41 citation statements)

References 24 publications

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“…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.…”

Section: Side-to-side Differences In Bone Mineral Levels and Soft Tismentioning

confidence: 96%

“…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].…”

Section: Side-to-side Differences In Bone Mineral Levels and Soft Tismentioning

confidence: 99%

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

et al. 2005

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Following a stroke, reduced level of physical activity and functional use of the paretic leg may lead to bone loss and muscle atrophy. These factors and the high incidence of falls may contribute to hip fractures in the stroke population. This study was the first to examine total proximal femur bone mineral content (BMC) and bone mineral density (BMD) and their relationship to strokespecific impairments in ambulatory individuals with chronic stroke (onset >1 year). We utilized dual-energy X-ray absorptiometry (DXA) to acquire proximal femur and total body scans on 58 (23 women) community-dwelling individuals with chronic stroke. We report total proximal femur BMC (g) and BMD (g/cm 2 ) derived from the proximal femur scans, and lean mass (g) and fat mass (g) for each leg derived from the total body scans. Each subject was evaluated for ambulatory capacity (Six Minute Walk Test), knee extension strength (hand-held dynamometry), physical fitness [Maximal oxygen uptake (VO 2 max)], and spasticity (Modified Ashworth Scale). Results showed that the paretic leg had significantly lower proximal femur BMD, lean mass, and percent lean mass but higher fat mass than the non-paretic leg for both men and women. Proximal femur BMD of the paretic leg was significantly related to ambulatory capacity (r=0.33, p=0.011), muscle strength (r=0.39, p=0.002), physical fitness (r=0.57, p<0.001) but not related to spasticity (r= −0.23, p=0.080). Multiple regression analysis showed that lean mass in the paretic leg was a major predictor (R 2 =0.371, p<0.001) of the paretic proximal femur BMD. VO 2 max was a significant predictor of both paretic proximal femur BMD (R 2 =0.325, p<0.001) and lean mass in the paretic leg (R 2 =0.700, p<0.001). Further study is required to determine whether increasing physical fitness and lean mass is important to improve hip bone health in chronic stroke.

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Section: Side-to-side Differences In Bone Mineral Levels and Soft Tismentioning

confidence: 96%

Section: Side-to-side Differences In Bone Mineral Levels and Soft Tismentioning

confidence: 99%

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

et al. 2005

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“…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].…”

Section: Stroke: a Model Of Disuse Osteoporosismentioning

confidence: 99%

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

Eng

Pang

Ashe

2008

JRRD

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Abstract-Fractures occur frequently in people living with stroke and have high personal, social, and economic costs for these individuals, their families, and the community. Exercise to reduce the risk of fragility fractures is a relatively new application in stroke rehabilitation but is a promising treatment with the potential to reduce the incidence of falls as well as maintain or improve bone health. In this article, we outline fracture risk factors and provide an overview of exercise interventions aimed at reducing fracture risk poststroke. Although randomized controlled trials support the use of exercise to reduce fracture risk factors poststroke, the body of literature is small and further studies are required. Further, the optimal dose of exercise and the additive effects of pharmacology on fracture risk need to be determined. Given the many health benefits associated with exercise, it should be considered an important modality for the management of falls and maintenance of bone health following stroke.

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“…• Evre 5 üst ekstremite (%); el (%) 6; 5 İnme sonrası gelişen KMY kaybının üst ekstremitede daha yoğun görülmesi, üst ekstremitede ve elde meydana gelen motor ve fonksiyonel kaybın alt ekstremiteye göre daha şiddetli olması ve sonrasında uzun immobilizasyon sürelerine yol açması ile ilişkili olduğu bildirilmektedir (26)(27)(28)(29)(30). 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).…”

Section: Brunnstrom Frekans Dağılımıunclassified

“…Nitekim bizim çalışmamızda da, üst ekstremite ve eldeki paralizinin derecesi (Brunnstrom evresi), elde spastisite düzeyi (Modifiye Ashworth Evresi) ile paretik taraftaki el KMY kaybı oranı arasında ilişki saptanmıştır, yani motor paralizi derecesi ve spastisite şiddeti arttıkça el KMY değerleri azalmaktadır. Hemiplejik hastalarda motor kaybın derecesi ve KMY kaybı arasındaki korelasyonun varlığı, pek çok çeşitli çalış-malarla desteklenmiştir (26)(27)(28)(29)(30). Spastisite şiddeti ile KMY değer-leri arasında negatif korelasyon tespit edilmiş; spastisite arttıkça mobilizasyonun ve fonksiyonel aktivitenin zorlaştığı, bunun da kemik kaybını hızlandırdığı bildirilmiştir (4).…”

Section: Brunnstrom Frekans Dağılımıunclassified

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...

show abstract

Osteoporosis in hemiplegic stroke patients as studied with dual-energy x-ray absorptiometry

Cited by 52 publications

References 24 publications

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

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

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

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

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