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Osteoporosis International

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01.06.2010 | Original Article

Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

verfasst von: M. Y. C. Pang, M. C. Ashe, J. J. Eng

Erschienen in: Osteoporosis International | Ausgabe 6/2010

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Abstract

Summary

The purpose of this study was to identify the determinants of the bone strength index of the distal tibia epiphysis in chronic stroke patients. The results showed that lower cardiovascular fitness, more muscle atrophy, poorer mobility, and more severe spasticity were independently associated with lower tibial bone strength index.

Introduction

To identify the determinants of the bone strength index (BSI) at the distal tibia in chronic stroke patients

Methods

Sixty-three chronic stroke survivors underwent scanning of the distal tibia at the 4% site on both sides using peripheral quantitative computed tomography. The primary outcomes were trabecular bone mineral density (BMD; milligram per cubic centimeter), total BMD (milligram per cubic centimeter), total bone area (square millimeter), and BSI (square gram per centimeter to the power of four). Cardiovascular fitness, leg lean mass, gait velocity, and spasticity were also measured.

Results

Scans from 45 subjects were deemed to have acceptable quality and were included for subsequent analysis. The paretic side had significantly lower trabecular BMD, total BMD, and BSI than the nonparetic side (p < 0.05). However, the total bone area demonstrated no significant side-to-side difference (p > 0.05). After adjusting for relevant biological factors, peak oxygen consumption, leg muscle mass, and gait velocity remained positively associated with tibial BSI on both sides (R ² change = 6.9–14.2%), whereas spasticity of the paretic leg was negatively associated with tibial BSI on the same side (R ² change = 4.8%).

Conclusions

Cardiovascular function, muscle atrophy, mobility, and spasticity are independently associated with BSI of the distal tibia epiphysis among chronic stroke patients.

Ramnemark A, Nyberg L, Borssén B et al (1998) Fractures after stroke. Osteoporos Int 8:92–95CrossRefPubMed

Dennis MS, Lo KM, McDowall M et al (2002) Fractures after stroke: frequency, types, and associations. Stroke 33:728–734CrossRefPubMed

Ramnemark A, Nilsson M, Borssén B et al (2000) Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 31:1572–1577PubMed

Poole KES, Reeve J, Warburton EA (2002) Falls, fractures, and osteoporosis after stroke. Time to think about protection? Stroke 33:1432–1436CrossRefPubMed

Di Monaco M, Vallero F, Di Monaco R et al (2003) Functional recovery and length of stay after hip fracture in patients with neurologic impairment. Am J Phys Med Rehabil 82:143–148CrossRefPubMed

Jorgensen L, Jacobsen BK, Wilsgaard T et al (2000) Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study. Osteoporos Int 11:381–387CrossRefPubMed

Jorgensen L, Crabtree NJ, Reeve J et al (2000) Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: bone adaptation after decreased mechanical loading. Bone 27:701–707CrossRefPubMed

Peacock M, Turner CH, Liu G et al (1995) Better discrimination of hip fracture using bone density, geometry, and architecture. Osteoporos Int 5:167–173CrossRefPubMed

Ashe MC, Fehling P, Eng JJ et al (2006) Bone geometric response to chronic disuse following stroke: a pQCT study. J Musculoskelet Neuronal Interact 6:226–233PubMed

10.

Pang MYC, Ashe MA, Eng JJ (2007) Muscle weakness, spasticity and disuse contribute to demineralization and geometric changes in the radius following chronic stroke. Osteoporosis Int 18:1243–1252CrossRef

11.

Pang MYC, Ashe MA, Eng JJ (2008) Tibial bone geometry in chronic stroke patients: influence of sex, cardiovascular health, and muscle mass. J Bone Miner Res 23:1023–1030CrossRefPubMed

12.

Melton LJ III, Brown RD Jr, Achenbach SJ et al (2001) Long-term fracture risk following ischemic stroke: a population study. Osteoporos Int 12:980–986CrossRefPubMed

13.

Pang MYC, Eng JJ, Dawson AS et al (2005) A community-based fitness and mobility exercise program for individuals with chronic stroke: a randomized controlled trial. J Am Geriatr Soc 53:1667–1674CrossRefPubMed

14.

Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state: a practical method for grading the state of patients for the clinician. J Psychiat Res 12:189–198CrossRefPubMed

15.

Washburn RA, Zhu W, McAuley E (2002) The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 83:193–200CrossRefPubMed

16.

Kontulainen S, Sievanen H, Kannus P et al (2002) Effect of long-term impact-loading on mass, size, and estimated strength of humerus and radius of female racquet-sports players: a peripheral quantitative computed tomography study between young and old starters and controls. J Bone Miner Res 17:2281–2289CrossRefPubMed

17.

Hangartner TN, Gilsanz V (1996) Evaluation of cortical bone by computed tomography. J Bone Miner Res 11:1518–525CrossRefPubMed

18.

Hayes W, Bouxsein ML (1997) Biomechanics of cortical and trabecular bone: implications for assessment of fracture risk. Basic orthopaedic biomechanics. Lippincott-Raven, Philadelphia

19.

Kontulainen SA, Johnston JD, Liu D et al (2008) Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact 8:401–409PubMed

20.

Macdonald HM, Kontulainen S, Petit M et al (2006) Bone strength and its determinants in pre-and early pubertal boys and girls. Bone 39:598–608CrossRefPubMed

21.

Wetzsteon RJ, Petit MA, Macdonald HM et al (2008) Bone structure and volumetric BMD in overweight children: a longitudinal study. J Bone Miner Res 23:1946–1953CrossRefPubMed

22.

Ashe MC, Liu-Ambrose T, Khan KM et al (2005) Optimizing results from pQCT: reliability of operator-dependent pQCT variables in cadavers and humans with low bone mass. J Clin Densitom 8:335–340CrossRefPubMed

23.

Flansbjer U-B, Holmback AM, Downham D et al (2005) Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 37:75–82CrossRefPubMed

24.

Bohannon BW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207PubMed

25.

Talbot LA, Metter EJ, Fleg JL (2000) Leisure-time physical activities and their relationship to cardiorespiratory fitness in healthy men and women 18–95 years old. Med Sci Sports Exerc 32:417–425CrossRefPubMed

26.

Steffen TM, Hacker TA, Mollinger L (2002) Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg balance scale, timed up and go test, and gait speeds. Phys Ther 82:128–137PubMed

27.

Rittweger J, Winwood K, Seynnes O et al (2006) Bone loss from the human distal tibia epiphysis during 24 days of unilateral lower limb suspension. J Physiol 577:331–337CrossRefPubMed

28.

Riggs LB, Melton LJ, Robb RA et al (2004) A population-based study of age and sex differences in bone volumetric density, size, geometry and structure at different skeletal sites. J Bone Miner Res 19:1945–1954CrossRefPubMed

29.

Russo CR, Lauretani F, Badinelli S et al (2003) Aging bone in men and women: beyond changes in bone mineral density. Osteoporos Int 14:531–538CrossRefPubMed

30.

Roth EJ (1993) Heart disease in patients with stroke: incidence, impact, and implications for rehabilitation. Part I: classification and prevalence. Arch Phys Med Rehabil 74:752–760CrossRefPubMed

31.

Kopunek SP, Michael KM, Shaughnessy M et al (2007) Cardiovascular risk in survivors of stroke. Am J Prev Med 32:408–412CrossRefPubMed

32.

Whitney C, Warburton ER, Frohlich J et al (2004) Are cardiovascular disease and osteoporosis directly linked? Sports Med 34:779–807CrossRefPubMed

33.

Osei-Hyiaman D, Ueji M, Toyakawa S (1999) Influence of hand grip strength on metacarpal bone mineral density in postmenopausal Japanese women: a cross-sectional study. Calcif Tissue Int 64:263–266CrossRefPubMed

34.

Chen Z, Lohman TG, Stini WA et al (1997) Fat or lean mass: which one is the major determinant of bone mineral mass in healthy postmenopausal women? J Bone Miner Res 12:144–151CrossRefPubMed

35.

Sato Y, Tsuru T, Oizumi K et al (1999) Vitamin K deficiency and osteopenia in disuse-affected limbs of vitamin D-deficient elderly stroke patients. Am J Phys Med Rehabil 78:317–322CrossRefPubMed

36.

Sato Y, Kuno H, Kaji M et al (1998) Increased bone resorption during the first year after stroke. Stroke 29:1373–1377PubMed

37.

Sato Y, Iwamoto J, Kanoko T et al (2005) Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovasc Dis 20:187–192CrossRefPubMed

38.

Hsu AL, Tang PF, Jan MH (2003) Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 84:1185–1193CrossRefPubMed

39.

Lau RWK, Pang MYC (2009) An assessment of the osteogenic index of therapeutic exercises for stroke patients: relationship to severity of leg motor impairment. Osteoporos Int 6:979–987CrossRef

40.

Eng JJ, Chu KS, Dawson AS et al (2002) Functional walk tests in individuals with stroke. Relation to perceived exertion and myocardial exertion. Stroke 33:756–561CrossRefPubMed

41.

Michael K, Macko RF (2007) Ambulatory activity intensity profiles, fitness, and fatigue in chronic stroke. Top Stroke Rehabil 14:5–12CrossRefPubMed

42.

Francisco GE, Hu MM, Boake C et al (2005) Efficacy of early use of intrathecal baclofen therapy for treating spastic hypertonia due to acquired brain injury. Brain Injury 19:359–364CrossRefPubMed

43.

Hesse S, Brandi-Hesse B, Bardeleben A et al (2001) Botulinum toxin A treatment of adult upper and lower limb spasticity. Drugs Aging 18:255–262CrossRefPubMed

44.

Kemmler W, Lauber D, Weineck J et al (2004) Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women; results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Int Med 164:1084–1091CrossRef

45.

Liu-Ambrose TY, Khan KM, Eng JJ et al (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom 7:390–398CrossRefPubMed

Titel: Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity
verfasst von: M. Y. C. Pang
M. C. Ashe
J. J. Eng
Publikationsdatum: 01.06.2010
Verlag: Springer-Verlag
Erschienen in: Osteoporosis International / Ausgabe 6/2010
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-009-1038-3

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