Progressive Osteoporosis in Hemiplegia

Denham, M. J.

doi:10.1159/000245472

Cited by 16 publications

(7 citation statements)

References 2 publications

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“…Losses of cortical bone in man are seen in immobilization [1][2][3] and in senile osteoporosis [4,5]. Studies in our laboratory have also shown characteristic losses of tibial cortical bone in restrained hypodynamic monkeys [6].…”

Section: Methodsmentioning

confidence: 92%

Tibial changes in experimental disuse osteoporosis in the monkey

1983

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We studied the mechanical properties and structural changes in the monkey tibia with disuse osteoporosis and during subsequent recovery. Bone bending stiffness was evaluated in relationship to microscopic changes in cortical bone and Norland bone mineral analysis. Restraint in the semireclined position produced regional losses of bone most obviously in the anterior-proximal tibiae. Following 6 months of restraint, the greatest losses of bone mineral in the proximal tibiae ranged from 23% to 31%; the largest changes in bone stiffness ranged from 36% to 40%. Approximately 8 1/2 months of recovery were required for restoration of normal bending properties. However, even after 15 months of recovery, bone mineral content did not necessarily return to normal levels. Histologically, resorption cavities in cortical bone were seen within 1 month of restraint; by 2 1/2 months of restraint there were large resorption cavities subperiosteally, endosteally, and intracortically. After 15 months of recovery, the cortex consisted mainly of first-generation haversian systems. After 40 months, the cortex appeared normal with numerous secondary and tertiary generations of haversian systems.

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Section: Methodsmentioning

confidence: 92%

Tibial changes in experimental disuse osteoporosis in the monkey

1983

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“…İnme sonrası ortaya çıkan komplikasyonlar arasında yer alan osteoporozun, kırık riskini genel popülasyona göre 2-4 kat daha fazla arttırdığı bildirildiğinden oldukça önem-li ancak bir o kadar da gözden kaçırılabilen bir durumdur (2)(3)(4)(5). Patogenezi net olarak bilinmese de genel ve lokal immobilizasyon başta olmak üzere ilerlemiş yaş, cinsiyet, spastisite şiddeti, kas atrofisi ile ilişkili olduğu bildirilmektedir (6,7).…”

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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“…It has been well documented that wasting of muscle and bone masses in the paretic limb is a prominent feature of hemiplegia and hemiparesis [1][2][3][4], because of longstanding disuse of the affected side [5][6][7][8]. Muscle wasting in the affected side causes greater vascular resistance, due to a decrease in venule density in skeletal muscle, leading to lower muscle flow rates [9].…”

Section: Introductionmentioning

confidence: 99%

Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis

et al. 2004

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Atherosclerosis has two key components, thickening and stiffening of arterial wall. These parameters are quantified ultrasonographically by IMT (intima-media thickness) and PWV (pulse wave velocity). In the present study, we determined the FA IMT (IMT of the bilateral femoral artery) and PWV of femoral-ankle (PWV fa) and brachial-ankle (PWV ba) segments in order to examine whether the degree of atherosclerosis is different between paretic and non-paretic lower limbs in 24 patients with hemiparesis. The values of PWV fa, PWV ba and FA IMT were all significantly greater on the paretic than the non-paretic side. Furthermore, significant decreases in masses of muscle, bone and fat, determined by dual-energy X-ray absorptiometry, were observed in paretic lower limbs compared with the non-paretic side. PWV fa correlated significantly and negatively with muscle mass ( r =-0.488, P =0.0004) and tended to correlate negatively with BMC (bone mineral content; r =-0.264, P =0.069) when statistical analyses were performed with the paretic and non-paretic sides together. Multiple regression analysis elucidated that the muscle mass was associated significantly with PWV fa and PWV ba, independent of age, duration after cerebrovascular accident, gender, bone and fat mass and FA IMT. The muscle mass was still associated with increased PWV fa and PWV ba when multivariate analysis was conducted independently in the paretic and non-paretic sides. In summary, our results indicated that arterial thickening and stiffening were greater on the paretic than the non-paretic side and suggested that a decrease of muscle mass might be associated with increased arterial stiffening in the paretic lower limb.

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Progressive Osteoporosis in Hemiplegia

Cited by 16 publications

References 2 publications

Tibial changes in experimental disuse osteoporosis in the monkey

Tibial changes in experimental disuse osteoporosis in the monkey

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis

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