Bone Mineral Density in Patients With Stroke: Relationship With Motor Impairment and Functional Mobility

 This from 2018 might help your incompetent doctor solve this problem if they have done nothing in the past 10 years!

Upright activity and higher motor function may preserve bone mineral density within 6 months of stroke: a longitudinal study January 2018

 The latest here:

Bone Mineral Density in Patients With Stroke: Relationship With Motor Impairment and Functional Mobility

Thomas J. Schnitzer

,

Richard L. Harvey

,

S. Hillary Nack

,

P. Supanwanid

,

L. Maskala-Streff

&

E. Roth

Pages 436-443 | Published online: 23 Dec 2014

• Cite this article
• https://doi.org/10.1310/tsr1905-436

 

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Abstract

Purpose: 

 Patients with stroke have a 2- to 4-fold increased risk of hip fracture compared to the general population, because of decreased bone mineral density (BMD) on the paretic side and the high incidence of accidental falls. However, the relationship between BMD and stroke-related motor impairment and functional mobility is not known. The purpose of this study was to investigate these relationships. 

Method: 

A convenience sample of 87 patients with stroke was recruited from an outpatient rehabilitation clinic. Demographics and clinical history were collected, and patients answered questionnaires regarding functional status. Motor impairment was assessed using motor items of the National Institutes of Health Stroke Scale (NIHSS), and BMD was measured using dual energy X-ray absorptiometry. 

Results: 

Mean BMD measured at the total hip was lower on the paretic side relative to the contralateral side (0.883 ± 0.148 g/cm² vs 0.923 ± 0.136 g/cm²; P < .001). Compared to patients without limitations in walking, those reporting limitations had lower BMD at the paretic total hip (0.808 ± 0.141 g/cm² vs 0.917 ± 0.139 g/cm²; P = .001) and lower BMD Z scores (–0.282 ± 0.888 vs –0.028 ± 0.813; P = .035). A significant correlation was found between mean BMD and the BMD Z score at the total hip on the paretic side and motor impairment in that lower extremity (r = –0.326, P = .003; r = –0.312, P = .004, respectively). 

Conclusion: 

 In patients with stroke, BMD at the paretic hip correlated with motor impairment. Furthermore, ability to ambulate was shown to be a simple yet useful test to determine which individuals had increased bone loss at the paretic versus nonparetic hip.

Upright activity and higher motor function may preserve bone mineral density within 6 months of stroke: a longitudinal study

You do realize that standing is one of the causes of falling and that falling after 65 results in death lots of time? Will your patients sign a waiver absolving you of killing them?
Upright activity and higher motor function may preserve bone mineral density within 6 months of stroke: a longitudinal study

Karen Borschmann

1,2

&

Sandra Iuliano

3,4

&

Ali Ghasem-Zadeh

3,4

&

Leonid Churilov

2

&

Marco Y. C. Pang

5

&

Julie Bernhardt

1,2

Received: 24 May 2017 /Accepted: 18 December 2017

#

The Author(s) 2018. This article is an open access publication

Abstract

Purpose: Bone fragility contributes to increased fracture risk, but little is known about the emergence of post-stroke bone loss. We investigated skeletal changes and relationships with physical activity, stroke severity, motor control and lean mass within 6 months of stroke.

Methods

This is a prospective observational study. Participants were non-diabetic but unable to walk within 2 weeks of first stroke. Distal tibial volumetric bone mineral density (vBMD, primary outcome), bone geometry and microstructure (high-resolution peripheral quantitative computed tomography) were assessed at baseline and 6 months, as were secondary outcomes total body bone mineral content and lean mass (dual energy X-ray absorptiometry), bone metabolism (serum osteocalcin, N-terminal propeptide of type 1 procollagen (P1NP), C-terminal telopeptide of type 1 collagen (CTX)), physical activity (PAL2 accelerometer) and motor control (Chedoke McMaster) which were also measured at 1 and 3 months.

Results

Thirty-seven participants (69.7 years (SD 11.6), 37.8% females, NIHSS 12.6 (SD 4.7)) were included. The magnitude of difference in vBMD between paretic and non-paretic legs increased within 6 months, with a greater reduction observed in paretic legs (mean difference = 1.5% (95% CI 0.5, 2.6), p= 0.007). At 6 months, better motor control was associated with less bone loss

since stroke (r=0.46, p= 0.02). A trend towards less bone loss was observed in people who regained independent walking compared to those who did not (p= 0.053). Higher baseline daily count of standing up was associated with less change in bone turnover over 6 months: osteocalcin (r=−0.51,

p=0.01),P1NP(r=−0.47, p = 0.01), CTX (r=−0.53, p = 0.01).

Conclusion

Better motor control and walking recovery were associated with reduced bone loss. Interventions targeting these impairments from early post-stroke are warranted.

Clinical trial registration

URL:

http://www.anzctr.org.au

. Unique identifier: ACTRN12612000123842.