Changes in Bone Mineral Content and Density After Stroke

Hamdy, Ronald C.; Krishnaswamy, Guha; Cancellaro, Vito; Whalen, K.; Harvill, Leo M.

doi:10.1097/00002060-199308000-00003

Cited by 56 publications

(42 citation statements)

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“…Our finding is thus comparable to Iversen et al [35] who reported a 10.3% side-toside difference in total arm BMC using single photon absorptiometry in 15 subjects who had a post-stroke duration of 23-38 weeks. Hamdy et al [20] reported a higher difference in BMC between the two arms (21.78%) using dual photon absorptiometry in a sample of 15 subjects with chronic stroke (mean onset=484 weeks). The higher degree of bone loss may be explained by the more severe motor paralysis in their sample (71% side-to-side difference in arm muscle strength) compared to our sample (32.5% side-to-side difference).…”

Section: Discussion Pronounced Side-to-side Difference Of Bone Mass Imentioning

confidence: 98%

“…Only a few studies have examined upper extremity bone health in the chronic stroke population (onset> 1 year) [15][16][17][18][19][20] and the results are inconsistent. For example, Hamdy et al [20] reported a significant 12.36% side-to-side difference in total arm bone mineral density (BMD) using dual photon absorptiometry in 15 subjects (mean post-stroke duration=9.3 years).…”

Section: Introductionmentioning

confidence: 99%

“…For example, Hamdy et al [20] reported a significant 12.36% side-to-side difference in total arm bone mineral density (BMD) using dual photon absorptiometry in 15 subjects (mean post-stroke duration=9.3 years). In contrast, Sahin et al [17] reported no significant side-to-side difference in BMD of the radius using dual-energy X-ray absorptiometry (DXA) in 30 subjects (mean post-stroke duration=1 year).…”

Section: Introductionmentioning

confidence: 99%

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Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

Pang

Eng

2005

Bone

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Individuals with stroke have a high incidence of bone fractures and approximately 30% of these fractures occur in the upper extremity. The high risk of falls and the decline in bone and muscle health make the chronic stroke population particularly prone to upper extremity fractures. This was the first study to investigate the bone mineral content (BMC), bone mineral density (BMD) and soft tissue composition of the upper extremities and their relationship to stroke-related impairments in ambulatory individuals with chronic stroke (onset >1 year). Dual-energy X-ray absorptiometry (DXA) was used to acquire total body scans on 56 (22 women) communitydwelling individuals (≥50 years of age) with chronic stroke. BMC (g) and BMD (g/cm 2 ), lean mass (g) and fat mass (g) for each arm were derived from the total body scans. The paretic upper extremity was evaluated for muscle strength (hand-held dynamometry), spasticity (Modified Ashworth Scale), impairment of motor function (Fugl-Meyer Motor Assessment) and amount of use of the paretic arm in daily activities (Motor Activity Log). Results showed that the paretic arm had significantly lower BMC (13.8%, p<0.001), BMD (4.5%, p<0.001) and lean mass (9.0%, p<0.001) but higher fat mass (6.3%, p=0.028) than the non-paretic arm. Multiple regression analysis showed that lean mass in the paretic arm, height and muscle strength were significant predictors (R 2 =0.810, p<0.001) of the paretic arm BMC. Height, muscle strength and gender were significant predictors (R 2 =0.822, p<0.001) of lean mass in the paretic arm. These results highlight the potential of muscle strengthening to promote bone health of the paretic arm in individuals with chronic stroke.

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Section: Discussion Pronounced Side-to-side Difference Of Bone Mass Imentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

Pang

Eng

2005

Bone

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“…Diverse pathologies such as osteolytic metastasis, Paget's disease and osteoporosis cause a loss in bone mass, and as a result there is skeletal pain and pathologic fracture increasing the morbidity for the patient (Hamdy et al, 1993;Manolagas and Jilka, 1995;Rodan and Martin, 2000). As evidenced for bone metastasis, a vicious cycle between osteoclasts, stromal cells/ osteoblasts, and cancer cells has been hypothesized during the progression of primary bone tumors (Chirgwin and Guise, 2000).…”

Section: Discussionmentioning

confidence: 99%

Alendronate induces anti-migratory effects and inhibition of neutral phosphatases in UMR106 osteosarcoma cells

Molinuevo

Bruzzone

Cortizo

2007

European Journal of Pharmacology

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Bisphosphonates are nonhydrolysable pyrophosphate analogues that prevent bone loss in several types of cancer. However, the mechanisms of anticancer action of bisphosphonates are not completely known. We have previously shown that nitrogen-containing bisphosphonates directly inhibit alkaline phosphatase of UMR106 rat osteosarcoma cells. In this study, we evaluated the effects of alendronate on the migration of UMR106 osteosarcoma using a model of multicellular cell spheroids, as well as the alendronate effect on neutral phosphatases. Alendronate significantly inhibited the migration of osteoblasts in a dose-dependent manner (10 − 6 -10 − 4 M). This effect was also dependent on calcium availability. The spheroid morphology and distribution of actin fibers were also affected by alendronate treatment. Alendronate dose-dependently inhibited neutral phosphatase activity in cell-free osteoblastic extracts as well as in osteoblasts in culture. Our results show that alendronate inhibits cell migration through mechanisms dependent on calcium, and that seem to involve inhibition of phosphotyrosine-neutral-phosphatases and disassembly of actin stress fibers.

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“…First, BMD in the paretic limbs is consistently lower than in the nonparetic limbs (by ≤20%) [38,40,[50][51][52][53][54]. The magnitude of the side-to-side difference found in individuals with stroke is much higher than that found between the dominant and nondominant sides in nondisabled older individuals (<1.5%) [55], which suggests a pronounced effect of hemiparesis on bone loss.…”

Section: Stroke: a Model Of Disuse Osteoporosismentioning

confidence: 95%

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

Eng

Pang

Ashe

2008

JRRD

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

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Changes in Bone Mineral Content and Density After Stroke

Cited by 56 publications

References 0 publications

Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

Alendronate induces anti-migratory effects and inhibition of neutral phosphatases in UMR106 osteosarcoma cells

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

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