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Bone-Density Changes After Stroke

Beaupre, Gary S. PhD; Lew, Henry L. MD, PhD

American Journal of Physical Medicine & Rehabilitation: May 2006 - Volume 85 - Issue 5 - p 464-472
doi: 10.1097/01.phm.0000214275.69286.7a
Invited Review: Stroke

Beaupre GS, Lew HL: Bone-density changes after stroke. Am J Phys Med Rehabil 2006;85:464–472.

It has been many years since bone loss and fracture risk were first recognized as serious complications of stroke. Hip fracture is associated with a substantial increase in morbidity and mortality for stroke survivors, and therefore, assessing and maintaining skeletal health after stroke should be an important clinical goal. Recent long-term, prospective studies have illustrated a highly nonuniform pattern of bone changes after stroke. In general, there is significant bone loss on the paretic side, which is greatest in those patients with the most severe functional deficits. In some patients, bone loss in the paretic arm during the first year after stroke is the equivalent of >20 yrs of bone loss in healthy individuals of comparable age. Bone density in the nonparetic upper limb can actually increase after stroke, consistent with an increase in habitual use of the nonparetic hand. Bone density in the paretic lower limb can decrease by >10% in <1 yr, with smaller decreases being typical for the nonparetic lower limb. Despite the recent increase in the number of prospective, longitudinal studies, important questions about bone changes after stroke remain unanswered. Longer-term studies quantifying bone loss for periods of >12 mos poststroke are needed to determine how long excess bone loss continues after stroke. Studies with more subjects and with more varied disability levels are needed to better understand the relationships between functional deficits and bone loss. New metrics are needed to quantify the intensity and duration of physical activity in the upper and lower limbs that are consistent with previous research on the role of mechanical stimuli in bone adaptation. Finally, an assessment of skeletal health and the factors that affect bone quantity and quality should be a standard component in the clinical management of all survivors of stroke.

From the Bone and Joint Center of Excellence (GSB) and the Physical Medicine and Rehabilitation Service (HLL), VA Palo Alto Health Care System, Palo Alto, California; and the Biomechanical Engineering (GSB) and Physical Medicine and Rehabilitation Divisions (HLL), Stanford University, Stanford, California.

All correspondence and requests for reprints should be addressed to Gary S. Beaupre, PhD, Bone and Joint Center of Excellence (153), VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.

Supported, in part, by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service, Merit Review grant B2748R.

© 2006 Lippincott Williams & Wilkins, Inc.