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Femoral Neck Bone Mineral Density Change Is Associated with Shift in Standing Weight in Hemiparetic Stroke Patients

Chang, Kwang-Hwa MD; Liou, Tsan-Hon MD, PhD; Sung, Jia-Ying MD, PhD; Wang, Chyan-Yeong MS, PT; Genant, Harry K. MD; Chan, Wing P. MD

American Journal of Physical Medicine & Rehabilitation: June 2014 - Volume 93 - Issue 6 - p 477–485
doi: 10.1097/PHM.0000000000000053
Original Research Articles

Objective The aim of this study was to explore the association between the proportion of body weight bearing of the paretic leg and the rate of femoral neck bone mineral density loss in acute first-ever stroke patients.

Design Patients were divided into those bearing less weight (<50%) on the paretic leg (n = 11) and those bearing more weight (≥50%) on the paretic leg (n = 11). The change in bone mineral density (grams per square centimeter per year) was calculated from the initial and follow-up dual-energy x-ray absorptiometry (≥6 mos). The proportion of body weight bearing was calculated from the body weight bearing of each leg, which was measured with the patient standing on a tilt table.

Results Compared with the patients bearing more weight on the paretic leg, the patients bearing less weight on the paretic leg had faster reduction in femoral neck bone mineral density. The proportion of body weight bearing was associated with the change in bone mineral density in the paretic (adjusted r2 = 51.0%, P < 0.001) and nonparetic (adjusted r2 = 32.4%, P < 0.005) legs.

Conclusions The stroke patients with proportion of body weight bearing of less than 50% on the paretic leg experienced faster bone loss and compromised bone density in the femoral neck. The proportion of body weight bearing may be useful to estimate the change in bone mineral density in paretic legs within the first year after stroke.

From the Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (K-HC, C-YW); Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan (K-HC, T-HL); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (T-HL); Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (J-YS); Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (J-YS); Department of Radiology, University of California, San Francisco, CA (HKG); Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (WPC); and Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (WPC).

All correspondence and requests for reprints should be addressed to: Wing P. Chan, MD, Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Rd, Section 3, Taipei 116, Taiwan.

Supported by grant 101-wf-eva-12 from Wan Fang Hospital, Taipei Medical University, and grant DOH101-TD-B-111-003 from the Center of Excellence for Clinical Trials and Research in Neuroscience, Department of Health, Executive Yuan, Taiwan.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins