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Sato, Yoshihiro MD2; Tsuru, Toshiomi MD; Oizumi, Kotaro MD; Kaji, Masahide MD

American Journal of Physical Medicine & Rehabilitation: July-August 1999 - Volume 78 - Issue 4 - p 317-322
Research Articles

Bone mineral density is reduced in stroke patients on the hemiplegic and contralateral sides, reflecting a degree of paralysis and vitamin D deficiency. Because the deficiency of vitamin K, a factor essential for site-specific carboxylation of bone Gla protein, is also associated with reduced bone mineral density, an additional contribution of vitamin K to bone changes was assessed in 168 elderly patients with long-standing post-stroke hemiplegia and hypovitaminosis D. Sera were analyzed to relate vitamin K1 concentrations to bone-related biochemical indexes and bone mineral density measured by radiodensitometry of the second metacarpal. Bone mineral density was lower on both sides in patients than in the 56 controls (P < 0.02). Serum vitamin K1 concentrations, which correlated positively with bone Gla protein concentrations (P < 0.0001), were lower in patients (0.48 ± 0.47 nmol/L) than controls (1.33 ± 0.49; P < 0.0001). Serum bone Gla protein and 25-hydroxyvitamin D concentrations were lower in patients than controls (P < 0.0001), whereas ionized Ca concentrations were higher in patients (1.277 ± 0.041 mmol/L) than controls (1.210 ± 0.049; P < 0.0001), correlating with the Barthel index. Multivariate linear regression identified vitamin K1, bone Gla protein, 25-hydroxyvitamin D, ionized calcium, and the Barthel index as independent bone mineral density determinants on the hemiplegic side and 25-hydroxyvitamin D, calcium, and the Barthel index on the intact side. Immobilization and vitamin K deficiency had stronger osteopenic effects on the hemiplegic side than contralaterally.

1From the Department of Neurology (YS, MK) and the First Department of Internal Medicine (TT, KO), Kurume University School of Medicine, Kurume, Japan.

2 All correspondence and requests for reprints should be addressed to: Department of Neurology, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume 839-0863, Japan.

© 1999 Lippincott Williams & Wilkins, Inc.