Ann Rehabil Med.  2024 Dec;48(6):413-422. 10.5535/arm.240079.

Discordance Between Spine-Hip and Paretic-Nonparetic Hip Bone Mineral Density in Hemiplegic Stroke Patients: A Multicenter Retrospective Study

• Yoo SD
• Kim TW
• Oh BM
• Lee SA
• Kim C
• Chung HY
• Son JE
• Lee JY
• Lee H
• Lee HY

• KMID: 2562972
• DOI: http://doi.org/10.5535/arm.240079

Abstract

Objective
To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.
Methods
This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.
Results
The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p<0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%–0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931–1.003, p<0.05).
Conclusion
Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.

Keyword

Bone density; Osteoporosis; Hip fractures; Stroke; Hemiplegia

Figure

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  Fig. 1. Flow chart of patient recruitment and retrospective study design. Patients with BMD T scores≤-2.5 at either the lumbar spine, femoral neck, or total proximal femur were classified to have osteoporosis. DXA, dual-energy X-ray absorptiometry; BMD, bone mineral density; WHO, World Health Organization; LS and PH BMD, lumbar spine and only paretic femoral neck and paretic total proximal femoral BMD; LS and NPH BMD, lumbar spine and only non-paretic femoral neck and non-paretic total proximal femoral BMD; LS and BH BMD, lumbar spine and both right and left femoral neck and total proximal femoral BMD; PH and NPH BMD, both paretic and non-paretic femoral neck and total proximal femoral BMD; D, discordance; C, concordance. a)The WHO classifies osteoporosis based on BMD measured by DXA, using T-scores. A T-score≥-1.0 is normal, between -1.0 and -2.5 indicates osteopenia, and ≤-2.5 defines osteoporosis. In this study, subjects with severe osteoporosis were excluded.

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  Fig. 2. Distribution of discordance according to the final diagnosis based on the World Health Organization criteria. BMD, bone mineral density; NPH, non-paretic hip; PH, paretic hip; BH, bilateral hips; LS, lumbar spine.

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  Fig. 3. Distribution of discordance according to the comparison sites based on the World Health Organization criteria. LS, lumbar spine.

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  Fig. 4. Distribution of discordance according to the time from stroke onset based on the World Health Organization criteria. NPH, non-paretic hip; PH, paretic hip; BH, bilateral hips; LS, lumbar spine.

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