Bone Mineral Density Alterations in Upper and Lower Extremities 12Months After Stroke Measured by Peripheral Quantitative Computed Tomography and DXA

Λαζούρα, Όλγα; Groumas, Nikos; Antoniadou, Eleftheria; Papadaki, Paraskevi J.; Papadimitriou, Alexandros; Thriskos, Paschalis; Fezoulidis, Ioannis; Vlychou, Marianna

doi:10.1016/j.jocd.2008.05.097

Cited by 45 publications

(44 citation statements)

References 28 publications

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“…3,12 There appears to be a correlation between functional status and changes in bone mineral density after stroke, with lower mobility associated with greater declines in bone density. 4,5,[34][35][36] Poststroke falls, which typically occur at times of transfer or during mobilization, may be particularly likely to result in injury or fractures as they tend to occur toward the hemiparetic side, where the bone mineral density may be lower and where the ipsilateral arm may be unable to break the fall. 6 Consistent with this, we found that fractures occurred in more than one quarter of those with falls in the 2 years after stroke.…”

Section: Resultsmentioning

confidence: 99%

Risk of fractures after stroke

et al. 2017

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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 5 23,751) or TIA (n 5 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 5 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. Stroke is a leading cause of adult disability, and up to two-thirds of stroke survivors have limitations in mobility.1 Stroke may also be associated with declines in bone mineral density and an increased risk of falls, both factors that can predispose to subsequent low-trauma (fragility) fractures. 2-10Previous studies have suggested an up to 4-fold increase in the risk of fractures in those with stroke compared to healthy controls. 7-13 However, it is not known how much of this fracture risk is due to the stroke itself rather than differences in other baseline factors such as age and comorbidity. A better understanding of both the fracture risk attributable to stroke and the specific factors associated with such fractures would allow for improved screening, prevention, and treatment of osteoporosis and fractures following stroke.We used data from a clinical stroke registry in Ontario, Canada, linked with administrative data, to evaluate the risk of fractures in patients with acute stroke compared to those with TIA. In order to focus on the contribution of stroke (rather than baseline comorbid conditions) to fracture risk, we selected patients with TIA as our reference population, as they are anticipated From the Institute for Clinical Evaluative Sciences

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Section: Resultsmentioning

confidence: 99%

Risk of fractures after stroke

et al. 2017

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“…Surprisingly, the degree of bone loss was more severe in men than in women. 21 The difference in severity of stroke-related impairments (i.e., motor skills, muscle weakness) between the two genders may possibly explain the findings, but unfortunately they were not measured in this study. Changes in bone geometry (e.g., total cross-sectional area, cortical bone area) were also not reported.…”

mentioning

confidence: 75%

“…Using a prospective study design, Lazoura and colleagues 21 found that the trabecular vBMD decreased by 14.0% on the paretic side and 6.8% on the non-paretic side between 3 and 12 months after stroke in a group of 43 men. No data on geometric properties were reported, but the decline in vBMD on the two sides contributed to a corresponding decrease in p-SSI (28.6% and 11.5%, respectively).…”

Section: Densitometric and Geometric Changes In The Radius Epiphysismentioning

confidence: 99%

Changes in Bone Density and Geometry of the Upper Extremities after Stroke: A Case Report

Pang

Yang

Lau

et al. 2012

Physiotherapy Canada

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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 (À12.1%) and bone strength index (À20.6%) 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.Key Words: bone and bones; osteoporosis; muscles; rehabilitation; stroke. RÉ SUMÉObjectif : Examiner les changements dans la densité et la gé omé trie osseuses de la ré gion de l'avant-bras et la fonction motrice d'un membre supé rieur paré tique chez une personne ayant subi un AVC subaigu (participant A). Description du client : Le participant A est â gé de 48 ans avec hé miparé sie du cô té droit. Intervention : Ne s'applique pas. Mesures et ré sultats : L'é valuation de la fonction des membres supé rieurs et une imagerie osseuse ont é té ré alisé es 3 mois, puis 12 mois suivant l'AVC. Le participant A avait une incapacité motrice modé ré e et une dysfonction grave du membre supé rieur paré tique 3 mois aprè s l'AVC. Au cours de la pé riode de suivi, aucun changement particulier de la fonction du membre paré tique supé rieur n'a é té observé . Aprè s un suivi de 12 mois, la densité miné rale osseuse surfacique (aBMD) de la ré gion mé diane et ultradistale de l'avant-bras paré tique, telle que mesuré e par absorptiomé trie aux rayons X à double intensité (DXA) affichait une ré duction considé rable de 7,9 % et de 5,9 %, respectivement. Le cô té non paré tique, au contraire, affichait une augmentation de densité miné rale ...

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“…Önceki yıllarda yapılmış çalışmalarda, üst ekstremite KMY'leri ve ilişkili risk faktörleri cinsiyetler arası farklar göz önünde bulundurulmadan yapılmıştır (4)(5)(6)(7)10,(12)(13)(14). Bizim çalışmamızda, cinsiyetler arası farklar incelendiğinde el KMY de-ğerlerinde hem erkeklerde hem kadınlarda sağlam ve hemiplejik taraf arasında fark bulunmakta olup, kadınlarda bu fark daha belirgindir.…”

Section: Brunnstrom Frekans Dağılımıunclassified

“…Ayrıca hemiplejik hastalarda, alt ekstremitede KMY kaybı ve kalça kırıkları ile ilgili çok sayıda çalışma ve derleme bulunmasına rağmen (10)(11)(12); motor kaybın genellikle daha ciddi düzeyde seyrettiği üst ekstremitede (13)(14)(15) ve özellikle de elde KMY kaybının araştırıldığı çalışmaların sayısı oldukça azdır.…”

Section: Introductionunclassified

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...

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Bone Mineral Density Alterations in Upper and Lower Extremities 12Months After Stroke Measured by Peripheral Quantitative Computed Tomography and DXA

Cited by 45 publications

References 28 publications

Risk of fractures after stroke

Risk of fractures after stroke

Changes in Bone Density and Geometry of the Upper Extremities after Stroke: A Case Report

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

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