Abstract
PurposeBone 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.MethodsThis 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.ResultsThirty-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).ConclusionBetter motor control and walking recovery were associated with reduced bone loss. Interventions targeting these impairments from early post-stroke are warranted.Clinical trial registrationURL: http://www.anzctr.org.au. Unique identifier: ACTRN12612000123842.
Highlights
Age-standardised hip fracture rates vary globally from < 10 to nearly 500/100,000 population [1], increased fracture risk is recognised as a common and serious stroke sequela [2,3,4]
By 6 months, vBMD reduced by 2.4% (SD 2.7, p = 0.001) in paretic legs, but did not change in nonparetic legs
Our data showed that higher motor control at 6 months after stroke and regaining the ability to walk were associated with less reduction in vBMD of paretic legs
Summary
Age-standardised hip fracture rates vary globally from < 10 to nearly 500/100,000 population [1], increased fracture risk is recognised as a common and serious stroke sequela [2,3,4]. The likelihood of hip fracture at 12 months post-stroke, in paretic legs, increases two to four times to that of age- and sex-matched controls [2, 5]. While bone loss and increased fracture risk in people with chronic stroke (> 12 months after onset) are well recognised, bone loss likely occurs early after stroke [7]. The magnitude of change that is expected to occur from early after stroke is unknown, and little is known about factors that may influence post-stroke bone loss
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