J Bone Metab.  2020 Nov;27(4):237-246. 10.11005/jbm.2020.27.4.237.

Does Hip Bone Density Differ between Paretic and Non-Paretic Sides in Hemiplegic Stroke Patients? and Its Relationship with Physical Impairment

Affiliations
  • 1Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2TBI Rehabilitation Center, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
  • 3Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
  • 4National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
  • 5Department of Rehabilitation Medicine, Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
  • 7Department of Internal Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
  • 8Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea

Abstract

Background
Bone loss after stroke escalates the risk of fractures, mainly in the hip, leading to further disability in individuals with stroke. We aimed to investigate the skeletal effect of bone mineral density (BMD) based on the duration of onset of stroke, compare the BMD of the paretic and non-paretic sides, and elucidate the relationship between BMD and disability variables.
Methods
The 31 male hemiplegic stroke patients between 20 and 70 years of age with cerebral infarction or hemorrhage were considered in this study. Subacute and chronic cases included 13 and 18 patients with lag time from the onset of 1 to 6 months and beyond 6 months, respectively. BMD in the lumbar, paretic, and non-paretic hip as well as the disability variables were analyzed retrospectively.
Results
The subacute group showed a significant reduction in the femoral neck BMD on the paretic side compared to that on the non-paretic side based on T-scores (P=0.013). Bone loss was significantly correlated with lower limb muscle strength and overall physical impairment (P<0.05). The chronic group demonstrated significant reduction in femur neck and total femur BMD on the paretic side compared to that on the non-paretic side based on T-scores (P=0.002 and P<0.001, respectively). T-scores of BMD in the chronic phase were not significantly associated with the clinical parameters.
Conclusions
Early screening of bilateral hip BMD in the early stages after stroke, monitoring, and timely implementation of prevention strategies are important to minimize subsequent bone loss and prevent possible complications in patients who experience stroke.

Keyword

Bone density; Immobilization; Osteoporosis; Rehabilitation; Stroke
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