1
|
Wang J, Sun Y, Guo X, Zhang Z, Liang H, Zhang T. The effect of stroke on the bone mineral density: A systematic review and meta-analysis. J Nutr Health Aging 2024; 28:100189. [PMID: 38350301 DOI: 10.1016/j.jnha.2024.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES Stroke survivors frequently encounter physical complications. This study aimed to evaluate the impact of stroke on bone mineral density (BMD) and assess the risk of post-stroke osteoporosis or osteoporotic fractures. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews to identify longitudinal studies reporting the influence of stroke on BMD, osteoporosis, and osteoporotic fractures. Pooled analyses were performed utilizing random-effects models. RESULTS This study included 21 studies with 1,029,742 participants. The mean difference of BMD in the paretic femoral neck between follow-up and initial measurements was -0.07 g/cm2 (95% CI, -0.09 to -0.04), and -0.03 g/cm2 (95% CI, -0.05 to -0.01) in the non-paretic femoral neck. A follow-up length exceeding six months was associated with a more pronounced decrease compared to a follow-up of under six months (MD, -0.08; 95% CI, -0.11 to -0.05 vs MD, -0.04; 95% CI, -0.06 to -0.02; P = 0.03). No significant change in lumbar spine BMD was detected post-stroke (MD, -0.00; 95% CI, -0.03 to 0.02), nor was significant change observed in the non-paretic distal radius, proximal humerus, tibia, trochanter, and total hip. Stroke was not associated with an increased risk of osteoporosis or osteoporotic fractures (HR, 1.43; 95% CI, 0.95-2.13). CONCLUSION Stroke survivors undergo significant BMD loss in paralyzed limbs, most notably in the femoral neck. However, BMD in the lumbar spine does not exhibit a significant decrease post-stroke. The risk of post-stroke osteoporosis or osteoporotic fractures should be interpreted with caution and needs further investigation.
Collapse
Affiliation(s)
- Jun Wang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, 100069, China; Lab of Brain Injury Repair and Rehabilitation, China Rehabilitation Science Institute, Beijing 100068, China; Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100077, China.
| | - Yanshan Sun
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Xiang Guo
- Department of Spine Surgery, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, 261041, China
| | - Zhen Zhang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Hanguang Liang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, 100069, China; Lab of Brain Injury Repair and Rehabilitation, China Rehabilitation Science Institute, Beijing 100068, China; Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100077, China.
| |
Collapse
|
2
|
Li J, Shi L, Sun J. The pathogenesis of post-stroke osteoporosis and the role oxidative stress plays in its development. Front Med (Lausanne) 2023; 10:1256978. [PMID: 37928460 PMCID: PMC10625412 DOI: 10.3389/fmed.2023.1256978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Cardiovascular disease and osteoporotic fractures (OF) are the main diseases affecting the health of middle-aged and elderly people. With the gradual increase of population aging in China and even the world, the incidence of the two and the prevalence of high-risk groups are also showing a continuous upward trend. The relationship between the two, especially the impact of cardiovascular disease on the risk and prognosis of OF, has attracted more and more attention. Therefore, it is of great significance to fully understand the pathogenesis of cardiovascular and cerebrovascular diseases and the resulting osteoporosis and to provide targeted interventions to prevent the occurrence of diseases and fractures. This article reviews the relationship between one of the Cardiovascular disease-stroke and related therapeutic drugs and the risk of OF, and the role of oxidative stress in its pathophysiological mechanism by reviewing relevant domestic and foreign literature in recent years, in order to gain a more comprehensive understanding of the association between stroke and OF, and then provide a basis and reference for screening high-risk groups of fractures and reducing the burden on the health system caused by the disease.
Collapse
Affiliation(s)
- JinYan Li
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Lin Shi
- Weifang People's Hospital, Weifang, China
| | - JianMin Sun
- School of Clinical Medicine, Weifang Medical University, Weifang, China
- Weifang People's Hospital, Weifang, China
| |
Collapse
|
3
|
Potin P, Degboé Y, Couture G, Marque P, De Boissezon X, Laroche M. Loss of bone mineral density in hemiplegic patients after stroke: Prospective single-center study. Rev Neurol (Paris) 2022; 178:808-811. [DOI: 10.1016/j.neurol.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
|
4
|
Miller T, Qin L, Hung VWY, Ying MTC, Tsang CSL, Ouyang H, Chung RCK, Pang MYC. Gait speed and spasticity are independently associated with estimated failure load in the distal tibia after stroke: an HR-pQCT study. Osteoporos Int 2022; 33:713-724. [PMID: 34636938 DOI: 10.1007/s00198-021-06191-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
UNLABELLED This HR-pQCT study was conducted to examine bone properties of the distal tibia post-stroke and to identify clinical outcomes that were associated with these properties at this site. It was found that spasticity and gait speed were independently associated with estimated failure load in individuals with chronic stroke. PURPOSE (1) To examine the influence of stroke on distal tibia bone properties and (2) the association between these properties and clinical outcomes in people with chronic stroke. METHODS Sixty-four people with stroke (age, 60.8 ± 7.7 years; time since stroke, 5.7 ± 3.9 years) and 64 controls (age: 59.4 ± 7.8 years) participated in this study. High-resolution peripheral quantitative computed tomography (HR-pQCT) was used to scan the bilateral distal tibia, and estimated failure load was calculated by automated finite element analysis. Echo intensity of the medial gastrocnemius muscle and blood flow of the popliteal artery were assessed with ultrasound. The 10-m walk test (10MWT), Fugl-Meyer Motor Assessment (FMA), and Composite Spasticity Scale (CSS) were also administered. RESULTS The percent side-to-side difference (%SSD) in estimated failure load, cortical area, thickness, and volumetric bone mineral density (vBMD), and trabecular and total vBMD were significantly greater in the stroke group than their control counterparts (Cohen's d = 0.48-1.51). Isometric peak torque and echo intensity also showed significant within- and between-groups differences (p ≤ 0.01). Among HR-pQCT variables, the %SSD in estimated failure load was empirically chosen as one example of the strong discriminators between the stroke group and control group, after accounting for other relevant factors. The 10MWT and CSS subscale for ankle clonus remained significantly associated with the %SSD in estimated failure load after adjusting for other relevant factors (p ≤ 0.05). CONCLUSION The paretic distal tibia showed more compromised vBMD, cortical area, cortical thickness, and estimated failure load than the non-paretic tibia. Gait speed and spasticity were independently associated with estimated failure load. As treatment programs focusing on these potentially modifiable stroke-related impairments are feasible to administer, future studies are needed to determine the efficacy of such intervention strategies for improving bone strength in individuals with chronic stroke.
Collapse
Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Vivian W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| |
Collapse
|
5
|
Policy analysis on power standing systems. Prev Med Rep 2021; 24:101601. [PMID: 34976658 PMCID: PMC8683940 DOI: 10.1016/j.pmedr.2021.101601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
Power wheelchairs provide people with mobility disabilities opportunities for independence in mobility and repositioning themselves. However, current power wheelchair power options covered by Medicare limit the person to a horizontal plane. In the home, access to the vertical plane is also required for mobility related activities of daily living. Power standing systems on power wheelchairs are one option for providing access to the vertical environment, although currently these systems are not covered by Medicare. Power standing systems also aid in medical management and in preventing common comorbidities associated with chronic neurological and congenital healthcare conditions. Therefore, a legal group led an interdisciplinary effort to change Medicare policy on power standing systems. A policy analysis using Bardach’s Eightfold policy framework was conducted to analyze a clinical groups’ action within this interdisciplinary team. The clinical team considered three viable options to address the problem and evaluated these options against five criteria. Ultimately, a national coverage determination reconsideration would provide a needed opportunity for the coverage of power standing systems. Suggested coverage criteria for power standing systems, based on existing literature and expert clinical experience, are proposed.
Collapse
|
6
|
Miller T, Ying MTC, Hung VWY, Tsang CSL, Ouyang H, Chung RCK, Qin L, Pang MYC. Determinants of estimated failure load in the distal radius after stroke: An HR-pQCT study. Bone 2021; 144:115831. [PMID: 33359893 DOI: 10.1016/j.bone.2020.115831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Bone health is often compromised after stroke and the distal radius is a common site of fragility fractures. The macro- and mircoproperties of bone tissue after stroke and their clinical correlates are understudied. The objectives of the study were to use High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) to investigate the bone properties at the distal radius, and to identify the correlates of estimated failure load for the distal radius in people with chronic stroke. This was a cross-sectional study of 64 people with stroke (age: 60.8 ± 7.7 years, stroke duration: 5.7 ± 3.9 years) and 64 age- and sex-matched controls. Bilateral bone structural, densitometric, geometric and strength parameters of the distal radius were measured using HR-pQCT. The architecture, stiffness and echo intensity of the bilateral biceps brachii muscle and brachial artery blood flow were evaluated using diagnostic ultrasound. Other outcomes included the Fugl-Meyer Motor Assessment (FMA), Motor Activity Log (MAL), and Composite Spasticity Scale (CSS). The results revealed a significant side (paretic vs non-paretic for the stroke group, non-dominant vs dominant for controls) by group (stroke vs control) interaction effect for estimated failure load, cortical area, cortical thickness, trabecular number and trabecular separation, and all volumetric density parameters. Post-hoc analysis showed percent side-to-side differences in bone outcomes were greater in the stroke group than the control group, with the exception of trabecular thickness and intracortical porosity. Among the HR-pQCT variables, percent side-to-side difference in trabecular volumetric bone mineral density contributed the most to the percent side-to-side difference in estimated failure load in the stroke group (R2 change = 0.334, β = 1.106). Stroke-related impairments (FMA, MAL, CSS) were found to be significant determinants of the percent side-to-side difference in estimated failure load (R2 change = 0.233, β = -0.480). This was the first study to examine bone microstructure post-stroke. We found that the paretic distal radius had compromised bone structural properties and lower estimated failure load compared to the non-paretic side. Motor impairment was a determinant of estimated bone strength at the distal radius and may be a potential intervention target for improving bone health post-stroke.
Collapse
Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
| | - Vivian W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| |
Collapse
|
7
|
Lee HY, Park JH, Lee H, Kim TW, Yoo SD. Does Hip Bone Density Differ between Paretic and Non-Paretic Sides in Hemiplegic Stroke Patients? and Its Relationship with Physical Impairment. J Bone Metab 2020; 27:237-246. [PMID: 33317227 PMCID: PMC7746477 DOI: 10.11005/jbm.2020.27.4.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
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.
Collapse
Affiliation(s)
- Hoo Young Lee
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea.,TBI Rehabilitation Center, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Jung Hyun Park
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyanglim Lee
- Department of Internal Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- TBI Rehabilitation Center, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Northuis CA, Crandall CJ, Margolis KL, Diem SJ, Ensrud KE, Lakshminarayan K. Association between post-stroke disability and 5-year hip-fracture risk: The Women's Health Initiative. J Stroke Cerebrovasc Dis 2020; 29:104976. [PMID: 32689623 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/11/2020] [Accepted: 05/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk. METHODS The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death. RESULTS Average age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant. CONCLUSION Severe disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.
Collapse
Affiliation(s)
- Carin A Northuis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Carolyn J Crandall
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | | | - Susan J Diem
- Division of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health & Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| |
Collapse
|
9
|
Yang FZ, Jehu DAM, Ouyang H, Lam FMH, Pang MYC. The impact of stroke on bone properties and muscle-bone relationship: a systematic review and meta-analysis. Osteoporos Int 2020; 31:211-224. [PMID: 31720713 DOI: 10.1007/s00198-019-05175-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/18/2019] [Indexed: 01/07/2023]
Abstract
To systematically review available evidence related to the characteristics of bone changes post-stroke and the relationship between various aspects of muscle function (e.g., strength, spasticity) and bone properties after stroke onset. An extensive online database search was undertaken (last search in January 2019). Articles that examined the bone properties in stroke patients were included. The quality of the studies was evaluated with the National Institutes of Health (NIH) Study Quality Assessment Tools. Publication bias of meta-analyses was assessed using the Egger's regression asymmetry test. The selection and evaluation of the articles were conducted by two independent researchers. Fifty-nine studies were identified. In subacute and chronic stroke studies, the skeletal sites in the paretic limbs sustained a more pronounced decline in bone quality than did their counterparts in the non-paretic limbs. The rate of changes showed a decelerating trend as post-stroke duration increased, but the timing of achieving the steady rate differed across skeletal sites. The magnitude of bone changes in the paretic upper limb was more pronounced than the paretic lower limb. There was a strong relationship between muscle strength/mass and bone density/strength index. Muscle spasticity seemed to have a negative impact on bone integrity in the paretic upper limb, but its influence on bone properties in the paretic lower limb was uncertain. Substantial bone changes in the paretic limbs occurred particularly in the first few months after stroke onset. Early intervention, muscle strength training, and long-term management strategies may be important to enhance bone health post-stroke. This review has also revealed the knowledge gaps which should be addressed in future research.
Collapse
Affiliation(s)
- F Z Yang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
- Department of Physical Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - D A M Jehu
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - H Ouyang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
- Department of Physical Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - F M H Lam
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - M Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong.
| |
Collapse
|
10
|
Cervinka T, Giangregorio L, Sievanen H, Cheung AM, Craven BC. Peripheral Quantitative Computed Tomography: Review of Evidence and Recommendations for Image Acquisition, Analysis, and Reporting, Among Individuals With Neurological Impairment. J Clin Densitom 2018; 21:563-582. [PMID: 30196052 DOI: 10.1016/j.jocd.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/07/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023]
Abstract
In 2015, the International Society for Clinical Densitometry (ISCD) position statement regarding peripheral quantitative computed tomography (pQCT) did not recommend routine use of pQCT, in clinical settings until consistency in image acquisition and analysis protocols are reached, normative studies conducted, and treatment thresholds identified. To date, the lack of consensus-derived recommendations regarding pQCT implementation remains a barrier to implementation of pQCT technology. Thus, based on description of available evidence and literature synthesis, this review recommends the most appropriate pQCT acquisition and analysis protocols for clinical care and research purposes, and recommends specific measures for diagnosis of osteoporosis, assigning fracture risk, and monitoring osteoporosis treatment effectiveness, among patients with neurological impairment. A systematic literature search of MEDLINE, EMBASE©, CINAHL, and PubMed for available pQCT studies assessing bone health was carried out from inception to August 8th, 2017. The search was limited to individuals with neurological impairment (spinal cord injury, stroke, and multiple sclerosis) as these groups have rapid and severe regional declines in bone mass. Of 923 references, we identified 69 that met review inclusion criteria. The majority of studies (n = 60) used the Stratec XCT 2000/3000 pQCT scanners as reflected in our evaluation of acquisition and analysis protocols. Overall congruence with the ISCD Official Positions was poor. Only 11% (n = 6) studies met quality reporting criteria for image acquisition and 32% (n = 19) reported their data analysis in a format suitable for reproduction. Therefore, based on current literature synthesis, ISCD position statement standards and the authors' expertise, we propose acquisition and analysis protocols at the radius, tibia, and femur sites using Stratec XCT 2000/3000 pQCT scanners among patients with neurological impairment for clinical and research purposes in order to drive practice change, develop normative datasets and complete future meta-analysis to inform fracture risk and treatment efficacy evaluation.
Collapse
Affiliation(s)
- T Cervinka
- Neural Engineering and Therapeutics Team, Toronto Rehabilitation Research Institute-University Health Network, Toronto, Ontario, Canada.
| | - L Giangregorio
- Neural Engineering and Therapeutics Team, Toronto Rehabilitation Research Institute-University Health Network, Toronto, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - H Sievanen
- Bone Research Group, UKK Institute, Tampere, Finland
| | - A M Cheung
- Centre of Excellence in Skeletal Health Assessment, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B C Craven
- Neural Engineering and Therapeutics Team, Toronto Rehabilitation Research Institute-University Health Network, Toronto, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada; Centre of Excellence in Skeletal Health Assessment, University Health Network, Toronto, Ontario, Canada; Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Finite element analysis of the wrist in stroke patients: the effects of hand grip. Med Biol Eng Comput 2017; 56:1161-1171. [DOI: 10.1007/s11517-017-1762-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/25/2017] [Indexed: 11/26/2022]
|
12
|
RAMLEE MUHAMMADHANIF, GAN KOKBENG. FUNCTION AND BIOMECHANICS OF UPPER LIMB IN POST-STROKE PATIENTS — A SYSTEMATIC REVIEW. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Current clinical services are struggling to provide the most favorable rehabilitation treatment for patients with stroke, which inspired researchers to investigate and explore the use of rehabilitation devices suitable for the patients and rehabilitation therapy. This review paper addresses the importance of biomechanical features in patients who experienced stroke to the upper limb. First and foremost, a review was done on general biomechanical description associated with motor control, shoulder, elbow, wrist and fingers joint. This included the ability of the patients to move their affected arm and the affect on peak joint torque, range of motion, joint forces, grip strength and muscle activities during the activities of daily living. In addition, we also reviewed the material properties and geometrical condition of tissue in stroke patient. The repercussions of post-stroke patient regarding the bone density, stiffness of muscle as well as the thickness of cartilage are described in this review. Based on the findings, the movement of affected stroke hand is associated with the motor control and material properties of tissue. To strengthen the motor control and maintaining tissue properties, early physical training on patients should be conducted in two to four weeks after stroke. In conclusion, this report suggests a new approach for future biomechanical studies in order to enhance the quality of physiotherapy rehabilitation peculiarly for post-stroke patients.
Collapse
Affiliation(s)
- MUHAMMAD HANIF RAMLEE
- Medical Devices and Technology Group (MEDITEG), Department of Clinical Science, Faculty of Biosciences and Medical Engineering (FBME), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Sport Innovation and Technology Group (SITC), Institute of Human Centered Engineering (IHCE), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | - KOK BENG GAN
- Department of Electrical, Electronic and System Engineering, Faculty of Engineering and Systems Engineering, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia
| |
Collapse
|
13
|
Kapral MK, Fang J, Alibhai SMH, Cram P, Cheung AM, Casaubon LK, Prager M, Stamplecoski M, Rashkovan B, Austin PC. Risk of fractures after stroke: Results from the Ontario Stroke Registry. Neurology 2016; 88:57-64. [PMID: 27881629 DOI: 10.1212/wnl.0000000000003457] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/22/2016] [Indexed: 01/07/2023] Open
Abstract
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 = 23,751) or TIA (n = 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 = 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.
Collapse
Affiliation(s)
- Moira K Kapral
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
| | - Jiming Fang
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Shabbir M H Alibhai
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Peter Cram
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Angela M Cheung
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Leanne K Casaubon
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Marla Prager
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Melissa Stamplecoski
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Brennan Rashkovan
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| | - Peter C Austin
- From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada
| |
Collapse
|
14
|
Lam FMH, Bui M, Yang FZH, Pang MYC. Chronic effects of stroke on hip bone density and tibial morphology: a longitudinal study. Osteoporos Int 2016; 27:591-603. [PMID: 26329101 DOI: 10.1007/s00198-015-3307-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The study aimed to quantify the long-term effects of stroke on tibial bone morphology and hip bone density. Only the trabecular bone mineral density and bone strength index in the hemiparetic tibial distal epiphysis showed a significant decline among individuals who had sustained a stroke 12-24 months ago. INTRODUCTION This study aims to determine the changes in bone density and morphology in lower limb long bones during a 1-year follow-up period and their relationship to muscle function in chronic stroke patients. METHODS Twenty-eight chronic stroke patients (12-166 months after the acute stroke event at initial assessment) and 27 controls underwent bilateral scanning of the hip and tibia using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Each subject was re-assessed 1 year after the initial assessment. RESULTS Twenty stroke cases and 23 controls completed all assessments. At the end of the follow-up, the paretic tibial distal epiphysis suffered significant decline in trabecular bone density (-1.8 ± 0.6 %, p = 0.006) and bone strength index (-2.7 ± 0.6 %, p < 0.001). More severe decline in the former was associated with poorer leg muscle strength (ρ = 0.447, p = 0.048) and motor recovery (ρ = 0.489, p = 0.029) measured at initial assessment. The loss in trabecular bone density remained significant among those whose stroke onset was 12-24 months ago (p < 0.001), but not among those whose stroke onset was beyond 24 months ago (p > 0.05) at the time of initial assessment. The changes of outcomes in the tibial diaphysis, except for cortical bone mineral content on the non-paretic side (-1.3 ± 0.3 %, p = 0.003), and hip bone density were well within the margin of error for precision. CONCLUSIONS There is evidence of continuous trabecular bone loss in the paretic tibial distal epiphysis among chronic stroke patients, but it tends to plateau after 2 years of stroke onset. The steady state may have been reached earlier in the hip and tibial diaphysis.
Collapse
Affiliation(s)
- F M H Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - M Bui
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - F Z H Yang
- Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - M Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| |
Collapse
|
15
|
Schnitzer TJ, Harvey RL, Hillary Nack S, Supanwanid P, Maskala-Streff L, Roth E. Bone Mineral Density in Patients With Stroke: Relationship With Motor Impairment and Functional Mobility. Top Stroke Rehabil 2014; 19:436-43. [DOI: 10.1310/tsr1905-436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
16
|
Borschmann K, Pang MYC, Iuliano S, Churilov L, Brodtmann A, Ekinci EI, Bernhardt J. Changes to volumetric bone mineral density and bone strength after stroke: a prospective study. Int J Stroke 2013; 10:396-9. [PMID: 24373530 DOI: 10.1111/ijs.12228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/10/2013] [Indexed: 01/04/2023]
Abstract
RATIONALE AND AIM Stroke survivors experience accelerated bone loss and increased fracture risk, particularly in paretic weight bearing limbs. Understanding how these changes unfold and their relationship to stroke severity and physical activity could help in the development of targeted interventions to prevent or reduce the severity of these outcomes. The primary aim of this study is to investigate the time course and magnitude of changes in volumetric bone mineral density within the first year after stroke, and to examine relationships with physical activity and motor recovery. DESIGN This is a prospective, observational study of 43 nondiabetic, nonambulant adults with first ever hemispheric stroke. PRIMARY OUTCOME The primary outcome was the difference in six-month change of total volumetric bone mineral density between paretic and nonparetic distal tibiae, measured at 7% of bone length site using high-resolution peripheral quantitative computed tomography. SECONDARY OUTCOMES The secondary outcomes are cortical and trabecular volumetric bone mineral density, cortical thickness, and total and cross-sectional areas of distal tibiae and radii of paretic and nonparetic limbs. Also included are total body and regional bone mineral density derived using dual-energy X-ray absorptiometry, physical activity measured using accelerometry, and motor recovery (Chedoke McMaster Stroke Assessment). DISCUSSION Measuring the timing and magnitude of changes to volumetric bone mineral density and bone structure from immediately after stroke, and relationships between these changes with physical activity and motor recovery will provide the basis for targeted interventions to reduce fracture risk in stroke survivors.
Collapse
Affiliation(s)
- Karen Borschmann
- School of Health Science, Latrobe University, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
17
|
Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention. Stroke Res Treat 2013; 2013:641943. [PMID: 24187647 PMCID: PMC3800649 DOI: 10.1155/2013/641943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/06/2013] [Accepted: 08/20/2013] [Indexed: 01/07/2023] Open
Abstract
Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3 ± 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%). This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed.
Collapse
|
18
|
Vascular elasticity and grip strength are associated with bone health of the hemiparetic radius in people with chronic stroke: implications for rehabilitation. Phys Ther 2013; 93:774-85. [PMID: 23431208 DOI: 10.2522/ptj.20120378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND People with stroke often have increased bone loss and fracture rate. Increasing evidence has demonstrated a link between cardiovascular health and bone loss in other patient populations. OBJECTIVE The study objectives were: (1) to compare the bone density and geometry of the radius diaphysis on the left and right sides in people with chronic stroke and people who were matched for age (control participants) and (2) to examine the relationship between the bone strength index at the hemiparetic radius diaphysis and vascular health in people with chronic stroke. DESIGN This was a case-control study. METHODS The radius diaphysis on both sides was scanned with peripheral quantitative computed tomography in 65 participants with chronic stroke and 34 control participants. Large-artery and small-artery elasticity indexes were evaluated with a cardiovascular profiling system. RESULTS The paretic radius diaphysis had significantly lower values for cortical bone mineral density, cortical thickness, cortical area, and the bone strength index but a larger marrow cavity area than the nonparetic radius diaphysis in participants with chronic stroke, whereas no bone measurement showed a significant side-to-side difference in control participants. Multiple regression analyses showed that the large-artery elasticity index and grip strength remained significantly associated with the bone strength index at the hemiparetic radius diaphysis after controlling for age, sex, time since stroke diagnosis, body mass index, and physical activity (R(2)=.790). LIMITATIONS This study was cross-sectional and could not establish causality. The radius diaphysis is not the most common site of fracture after stroke. CONCLUSIONS Both the integrity of the vasculature and muscle strength were significantly associated with the bone strength index at the hemiparetic radius diaphysis in participants with chronic stroke. The results may be useful in guiding rehabilitative programs for enhancing bone health in the paretic arm after stroke.
Collapse
|
19
|
de Brito CMM, Garcia ACF, Takayama L, Fregni F, Battistella LR, Pereira RMR. Bone loss in chronic hemiplegia: a longitudinal cohort study. J Clin Densitom 2013; 16:160-7. [PMID: 22677198 DOI: 10.1016/j.jocd.2012.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to evaluate hemiplegic stroke patients in terms of long-term changes in bone mineral density and related factors. We conducted a longitudinal cohort study, involving 57 first-stroke patients (40 males) with chronic hemiplegia (for more than 12mo), at a university rehabilitation center in the city of São Paulo, Brazil. Bone loss, body composition, lean mass, and fat mass were evaluated at 2 time points (mean interval, 16mo). Bone loss was significantly greater in paretic forearms than in nonparetic forearms (p=0.001) and in patients having suffered strokes more recently (p=0.015). We found no difference between paretic and nonparetic femurs. Femoral bone loss was significantly greater in patients using anticoagulants or anticonvulsants (p=0.025) and in those with greater spasticity (p=0.040), regardless of the time since stroke. Our results provide additional evidence that hemiplegic stroke patients have progressive bone loss and that such bone loss is more common in the arms than in the legs. Patients with poststroke hemiplegia should be densitometric monitored mainly in paretic arm and treated for bone loss, with attention to the determinants identified in this study.
Collapse
Affiliation(s)
- Christina May Moran de Brito
- Instituto de Medicina Física e Reabilitação (IMREA, Institute of Physical Medicine and Rehabilitation), do Hospital das Clínicas da Faculdade de Medicina da, University of São Paulo School of Medicine, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
20
|
Pang MYC, Yang FZH, Lau RWK, Cheng AQ, Li LSW, Zhang M. Changes in bone density and geometry of the upper extremities after stroke: a case report. Physiother Can 2013; 64:88-97. [PMID: 23277690 DOI: 10.3138/ptc.2010-34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to examine changes in bone density and geometry of the forearm region and motor function of the paretic upper extremity in a person with subacute stroke. Client Description: The participant was a 48-year-old man with right hemiparesis. INTERVENTION Not applicable. Measures and Outcomes: The assessment of upper-extremity (UE) function and bone imaging took place at 3 months and 12 months after stroke. The participant had moderate motor impairment and severe disuse of the paretic UE 3 months after stroke. During the follow-up period, no substantial change in paretic UE function was observed. At the 12 month follow-up, the areal bone mineral density (aBMD) of the ultradistal and mid-regions of the paretic forearm, as measured by dual-energy X-ray absorptiometry, sustained a significant reduction of 7.9% and 5.9%, respectively. The non-paretic side, in contrast, had a significant 4.0% increase in aBMD of the mid-forearm and a 2.8% increase in aBMD of the total forearm. Significant findings from peripheral quantitative computed tomography were a reduction in total volumetric bone mineral density (-12.1%) and bone strength index (-20.6%) in the radius distal epiphysis on the paretic side and an increase in cortical bone mineral content (2.0%) and bone strength index (7.6%) in the radius diaphysis on the non-paretic side. IMPLICATIONS After a stroke that resulted in moderate to severe UE impairment, a significant decline in bone mineral density was identified in various skeletal sites in the forearm region as the participant entered the subacute and chronic stages of recovery. The results point to the potential importance of early rehabilitative intervention in preventing unfavourable bone changes in the paretic upper limb among individuals with stroke.
Collapse
Affiliation(s)
- Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | | | | | | | | | | |
Collapse
|
21
|
Differences in tibia morphology between the sound and affected sides in ankle-foot orthosis-using survivors of stroke. Arch Phys Med Rehabil 2012; 94:510-5. [PMID: 23123505 DOI: 10.1016/j.apmr.2012.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/11/2012] [Accepted: 10/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine differences in tibia and proximal femur morphology between the affected and sound limbs in ankle-foot orthosis (AFO)-using survivors of stroke. DESIGN Observational study. SETTING A university bone density laboratory. PARTICIPANTS Ambulatory, AFO-using survivors of stroke (N=9; age range, 55-74y; poststroke duration, 13.5±4.4y; AFO use, 6.5±1.4y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Total body and hip areal bone mineral density (aBMD) and bone mineral content (BMC) were assessed by dual-energy x-ray absorptiometry. The 4%, 38%, and 66% sites of both tibias were measured with peripheral quantitative computed tomography for total, cortical, and trabecular volumetric BMD (vBMD) and BMC. Bone geometry, bone strength index (BSI), strength strain index (SSI), and minimum and maximum rotated moments of inertia (Imin, Imax) were determined. RESULTS Total hip and trochanter BMC and aBMD were 7% to 19% greater on the sound side (P<.05). Total BMC and vBMD were 2% to 21% greater (P<.05) on the sound limb, depending on site. Trabecular BMC and vBMD and BSI values were 19%, 21%, and 31% higher (P<.05) on the sound limb at the 4% site. Cortical BMC and vBMD (P<.05), and cortical thickness (P<.01) were greater on the sound side at the 38% and 66% sites. Cortical area and bone strength (SSI, Imin) were greater (P<.05) at the 66% site. Endosteal circumferences were greater on the affected side (P<.01). CONCLUSIONS Interlimb differences in bone characteristics after a stroke persist despite returning to ambulatory status with AFO use.
Collapse
|
22
|
Pang MYC, Cheng AQ, Warburton DE, Jones AYM. Relative impact of neuromuscular and cardiovascular factors on bone strength index of the hemiparetic distal radius epiphysis among individuals with chronic stroke. Osteoporos Int 2012; 23:2369-79. [PMID: 22310956 DOI: 10.1007/s00198-012-1899-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
Abstract
UNLABELLED The objective of this study was to examine the associations of neuromuscular and cardiovascular impairments with the bone strength index of the hemiparetic distal radius epiphysis in chronic stroke survivors. The results showed that grip strength is the most predominant predictor of the bone strength index. INTRODUCTION The purpose of the study was to examine the associations of neuromuscular and cardiovascular impairments with the bone strength index of the hemiparetic distal radius epiphysis in chronic stroke survivors. METHODS Sixty-five chronic stroke survivors and 34 healthy control subjects underwent scanning of the distal radius epiphyseal site on both sides using peripheral quantitative computed tomography to measure trabecular volumetric bone mineral density (vBMD) (mg/cm(3)), total vBMD (mg/cm(3)), total area (mm(2)), and compressive bone strength index (cBSI) (g(2)/cm(4)). Various indicators of neuromuscular (grip strength, spasticity) and cardiovascular function (vascular elasticity, oxygen consumption during 6-min walk test) were evaluated. RESULTS Analysis of variance revealed a significant main effect of side (p < 0.001) and group × side interaction (p < 0.05) for total BMC, total vBMD, trabecular vBMD, and cBSI (p < 0.05), with the stroke group showing greater side-to-side difference in these variables. However, no significant side-to-side difference in total area was detected in either group (p > 0.05). Sex-specific analysis yielded similar results. Multiple regression analyses revealed that the cBSI of the hemiparetic distal radius epiphysis had a stronger association with neuromuscular factors than cardiovascular factors. Overall, grip strength was the strongest determinant of the cBSI of the hemiparetic distal radius epiphysis (p < 0.01). CONCLUSIONS Muscle weakness is the most predominant determinant of cBSI in the hemiparetic distal radius epiphysis among chronic stroke patients. Future studies should investigate the efficacy of different muscle-strengthening strategies in enhancing bone strength of this skeletal site in the chronic stroke population.
Collapse
Affiliation(s)
- M Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | | | | | | |
Collapse
|
23
|
Lala D, Cheung AM, Gordon C, Giangregorio L. Comparison of cortical bone measurements between pQCT and HR-pQCT. J Clin Densitom 2012; 15:275-81. [PMID: 22542223 DOI: 10.1016/j.jocd.2012.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/10/2012] [Accepted: 01/16/2012] [Indexed: 11/15/2022]
Abstract
The primary purpose of this study was to determine the accuracy of tibial cortical thickness measurements derived from peripheral quantitative computed tomography (pQCT) with analysis based on the circular ring model, using high-resolution peripheral quantitative computed tomography (HR-pQCT) (isotopic voxel size of 82 μm) as a gold standard. The secondary objective was to evaluate whether the accuracy of the pQCT-based estimates of cortical thickness (CTh), cortical area (CoA), cortical density (CDen), and total area (TotA) improve with alterations of voxel size from the standard 0.5-0.2mm. Fifteen dry tibia specimens were immersed in saline in a sealed cylinder and scanned 22.5mm from the distal tibia plateau using pQCT and HR-pQCT. pQCT yielded higher values for CTh and CDen and lower values for CoA. The differences between imaging techniques increased as the average CTh increased. No systematic bias was observed for CDen, CoA, and TotA. Similar differences were found between pQCT with voxel size 0.2mm and HR-pQCT. Significant correlations were observed for CTh (R=0.97, p ≤ 0.0001), CDen (R=0.99, p ≤ 0.0001), CoA (R=0.98, p ≤ 0.0001), and TotA (R=1.0, p ≤ 0.0001) when pQCT- and HR-pQCT-derived values were compared irrespective of which voxel size was used. Measurement variability between the imaging techniques was evident. Future studies aimed at examining cortical structure with pQCT should note that there are differences between the 2 techniques.
Collapse
Affiliation(s)
- Deena Lala
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | | |
Collapse
|
24
|
Schäfer ML, Böttcher J, Pfeil A, Hansch A, Malich A, Maurer MH, Streitparth F, Röttgen R, Renz DM. Comparison between amputation-induced demineralization and age-related bone loss using digital X-ray radiogrammetry. J Clin Densitom 2012; 15:135-45. [PMID: 22560013 DOI: 10.1016/j.jocd.2011.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022]
Abstract
Digital X-ray radiogrammetry (DXR) is a computer-assisted automatic osteodensitometric tool. This study was performed to compare DXR measurements between bone changes following amputation trauma and age-related bone loss. Thirty-five men, who had undergone finger amputations, received a baseline examination and 2--3 serial measurements. As a second group, 215 males older than 70yr were enrolled. All patients obtained standardized hand radiographs. The following DXR parameters evaluating metacarpals were considered: cortical bone mineral density (DXR-BMD), cortical thickness (DXR-CT), metacarpal index (DXR-MCI), outer bone diameter (width; DXR-W), and inner medullary diameter (DXR-MD). In the amputation group, the DXR parameters showed an accentuated initial decrease between first and second measurements (DRX-BMD--12.7%, DXR-CT--14.2%, DXR-W--8.6%, DXR-MCI--6.1%; p<0.001) followed by a less pronounced reduction between second and third radiographs (DRX-BMD--0.5%, DXR-CT--1.5%, DXR-W--0.1%, DXR-MCI--1.3%). DXR-MD revealed a reduction of--3.6% (p<0.05) between first and second estimates and a non-significant increase (+1.1%) between second and third measurements. When compared with the second and third estimates in the amputation group, men older than 70yr presented lower DXR-BMD, DXR-CT, and DXR-MCI values (p<0.001), but larger metacarpal outer and inner bone diameters (DXR-W and DXR-MD; p<0.001). DXR-MD of the elderly men group was also more extended when compared with the baseline measurements of the amputation cohort (p<0.001). The early accentuated cortical bone loss and particularly the pronounced decrease of the outer bone width seem to be characteristic for amputation-induced osteoporosis, suggesting that this might be a distinct secondary osteoporosis entity. When compared with amputation-associated osteoporosis, where the bone loss occurs to a higher extent in the outer bone diameter than in the medullary cavity, the age-related bone changes lead more to an increase of the medullary diameter than of the outer bone width.
Collapse
Affiliation(s)
- Max-Ludwig Schäfer
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Colón-Emeric C, O'Connell MB, Haney E. Osteoporosis piece of multi-morbidity puzzle in geriatric care. ACTA ACUST UNITED AC 2011; 78:515-26. [PMID: 21748741 DOI: 10.1002/msj.20269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoporosis frequently coexists with other chronic diseases and syndromes of aging, and therefore multimorbidity interactions can potentially complicate its evaluation and treatment. This article reviews osteoporosis comorbidity interactions with select common diseases of aging including cardiovascular, neurologic, and geriatric syndromes, and select commonly used medications by older adults. Using depression as a case example, we describe the complex relationship between osteoporosis, mood, and antidepressant medications, and the implications of these interactions for patients and clinicians.
Collapse
Affiliation(s)
- Cathleen Colón-Emeric
- Duke University Medical Center and the Durham VA Geriatric Research, Education, and Clinical Center, Durham, NC, USA.
| | | | | |
Collapse
|
26
|
Alexandre C, Vico L. Pathophysiology of bone loss in disuse osteoporosis. Joint Bone Spine 2011; 78:572-6. [DOI: 10.1016/j.jbspin.2011.04.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2011] [Indexed: 12/31/2022]
|
27
|
Zikan V. Bone health in patients with multiple sclerosis. J Osteoporos 2011; 2011:596294. [PMID: 21603140 PMCID: PMC3096310 DOI: 10.4061/2011/596294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/02/2011] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis (MS) is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs) treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and resorption with depressed bone formation and a marked disruption of mechanosensory network of tightly connected osteocytes due to increase of osteocyte apoptosis. Patients with higher level of disability have also higher risk of falls that combined with a bone loss increases the frequency of bone fractures. There are currently no recommendations how to best prevent and treat osteoporosis in patients with MS. However, devastating effect of immobilization on the skeleton in patients with MS underscores the importance of adequate mechanical stimuli for maintaining the bone structure and its mechanical competence. The physical as well as pharmacological interventions which can counteract the bone remodeling imbalance, particularly osteocyte apoptosis, will be promising for prevention and treatment of osteoporosis in patients with MS.
Collapse
Affiliation(s)
- Vit Zikan
- Department of Internal Medicine 3, Faculty of Medicine 1, Charles University, 128 00 Prague, Czech Republic
| |
Collapse
|
28
|
Lazoura O, Papadaki PJ, Antoniadou E, Groumas N, Papadimitriou A, Thriskos P, Fezoulidis IV, Vlychou M. Skeletal and body composition changes in hemiplegic patients. J Clin Densitom 2010; 13:175-80. [PMID: 20347365 DOI: 10.1016/j.jocd.2010.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 12/18/2009] [Accepted: 01/11/2010] [Indexed: 11/27/2022]
Abstract
Hemiplegic patients are prone to bone loss and alterations in fat and lean mass, which ultimately affect their rehabilitation status and propensity in bone fractures. The present study aimed to evaluate body composition and bone mineral density (BMD) in stroke patients within 1st year post-stroke. Fifty-eight hemiplegic patients (36 men and 22 women) were enrolled in this prospective study. Dual-energy X-ray absorptiometry was used to assess total-body and lower-extremity BMDs (g/cm(2)), lean mass (g), and fat mass (g) after 3, 6 and 12 mo of stroke that led to hemiplegia. The Modified Ashworth Scale and the functional ambulation category were used to evaluate spasticity and ambulatory category of patients, respectively. Both sexes exhibited total-body and paretic lower-limb BMD loss, fat mass gain, and lean mass waste during the 1st 12 mo poststroke, and in most cases, statistically significant differences were found between 3 and 6 mo; however, the pattern of changes was different between males and females. Therefore, it is suggested that disability because of hemiplegia led to alterations in muscle function, which triggered skeletal and body composition changes and rendered these patients particularly prone to increased fracture risk.
Collapse
Affiliation(s)
- Olga Lazoura
- Department of Radiology, National Rehabilitation Centre, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
In 2004 the Stroke Association stated ‘Each year over 130,000 people in England and Wales have a stroke. Of all people who suffer from a stroke, about a third are likely to die within the first 10 days, about a third are likely to make a recovery within one month and about a third are likely to be left disabled and needing rehabilitation. Stroke has a greater disability impact than any other medical condition. A quarter of a million people are living with long-term disability as a result of stroke in the UK.’
Collapse
|