Original ArticleSkeletal and Body Composition Changes in Hemiplegic Patients
Introduction
Fractures and bone loss are well-established complications of stroke. Several studies have shown an increased bone loss in stroke patients, especially on the hemiplegic side, which is a prominent risk factor for fracture 1, 2, 3, 4, 5. Muscle atrophy associated with stroke is also a risk factor for fracture, because changes in muscle and fat mass may affect energy absorption during falls 1, 6, 7, 8, 9, 10.
Persistent hemiparesis is present in nearly 50% of all long-term ischemic stroke survivors (11). Within the 1st 2 yr poststroke, one-third of the survivors sustain a hip fracture and 24% sustain a wrist fracture (12). Upper-extremity fractures account for 27–36% of all fractures in the stroke population (13). Nearly all fractures occur on the hemiplegic side, and although the tendency to fall to the hemiplegic side is clearly a risk factor, reduced bone mineral density (BMD) and muscle weakness may also play an important role 11, 14.
Patients who sustain a stroke experience an exacerbation of the changes that occur during normal aging and include sarcopenia and fat mass increase, which are associated with old age sedentary lifestyle 11, 15. Hemiparesis after stroke may lead to muscle atrophy as a result of disease or altered central neural innervations 11, 16.
Dual-energy X-ray absorptiometry (DXA) has been used as the gold standard for the assessment of bone mineral content, and most of the published data with respect to bone changes in stroke patients have been documented by DXA measurements. Areal bone mineral density (BMDa), as measured by DXA, provides only a 2-dimensional view of the bone and cannot evaluate true bone density or describe its geometric properties. However, DXA is a method that provides a good estimate of bone strength. Total-body composition, as well as BMD, fat mass, and lean mass of each limb can also be evaluated by DXA 3, 7, 13, 17.
The purpose of the present study was to evaluate lean, fat, and bone mass changes of the whole body and lower extremities 3, 6, and 12 mo after stroke using DXA and to obtain information about the factors influencing these changes over the time after stroke.
Section snippets
Subjects
The study consisted of 58 acute stroke patients (22 women, with mean age of 62.3 yr, and 36 men, with mean age of 65.7 yr) admitted to our National Rehabilitation Centre within a time frame of 2.5 yr.
Acute stroke patients who received medical care and follow up in our Hospital were considered for recruitment. The diagnosis of stroke was confirmed by cranial computed tomography. Inclusion criteria were as follows: (1) all patients had sustained a single stroke that had occurred between 1 and 3 mo
Results
Data for the body indices are shown at Table 1 and for the limb indices are shown at Table 2. The data for the interaction plots are the log-transformed data depicted in Table 2. The profile of the patients in our study group is described in Table 3. All interaction plots are included in Fig. 1. The data for the interaction plots are the log-transformed data depicted in Table 2.
Discussion
Patients with hemiplegia after stroke are prone to osteoporosis and disuse muscle atrophy because of decrease or lack of functional use of the paretic extremities 1, 14. Moreover, they are more prone to falls because of balance deficits and muscle weakness. All these factors contribute to the 2- to 4-time higher risk for hip fractures in stroke patients compared with that in the reference population 2, 12, 17, 22, 23. Immobilized stroke patients experience a rapid reduction in muscle mass and,
References (30)
- et al.
Bone mineral density alterations in upper and lower extremities 12 months after stroke measured by peripheral quantitative computed tomography and DXA
J Clin Densitom
(2008) - et al.
Disuse muscle atrophy of lower limbs in hemiplegic patients
Arch Phys Med Rehabil
(1997) - et al.
Changes in muscle mass, fat mass, and bone mineral content in the legs after stroke: a 1 year prospective study
Bone
(2001) - et al.
Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients
Arch Phys Med Rehabil
(2002) - et al.
Accelerated bone remodeling in patients with poststroke hemiplegia
J Stroke Cerebrovasc Dis
(1998) Abnormal bone and calcium metabolism in patients after stroke
Arch Phys Med Rehabil
(2000)- et al.
Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals
Bone
(2004) - et al.
Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry
Arch Phys Med Rehabil
(1999) - et al.
The effect of hemiplegia on bone mass and soft tissue body composition
Acta Neurol Scand
(1989) - et al.
Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study
Osteoporos Int
(2000)
Bone mineral density in patients with stroke
Int J Rehabil Res
Falls, fractures, and osteoporosis after stroke: time to think about protection?
Stroke
Muscular atrophy in the hemiplegic thigh in patients after stroke
Am J Phys Med Rehabil
Body composition after stroke
Int J Rehabil Res
Skeletal muscle changes after hemiparetic stroke and potential beneficial effects of exercise intervention strategies
J Rehabil Res Dev
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