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Chronic effects of stroke on hip bone density and tibial morphology: a longitudinal study
F M H Lam1, M Bui2, F Z H Yang3
1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. freddy.lam@connect.polyu.hk.
Insights
Stroke survivors experience ongoing bone loss in the paretic tibia, particularly within 2 years of the event. This decline in trabecular bone density and strength is linked to muscle function and motor recovery.
Area of Science:
- Orthopedics
- Neurology
- Bone Metabolism
Background:
- Stroke significantly impacts lower limb bone health and muscle function in chronic patients.
- Understanding long-term bone changes is crucial for managing post-stroke complications.
Purpose of the Study:
- To quantify 1-year changes in bone density and morphology of lower limb long bones in chronic stroke patients.
- To investigate the relationship between these bone changes and muscle function.
Main Methods:
- Bilateral hip and tibia scanning using DXA and pQCT in 28 stroke patients and 27 controls.
- 1-year follow-up assessments to track changes in bone parameters and muscle function.
Main Results:
- Significant decline in trabecular bone density and bone strength index in the paretic tibial distal epiphysis.
- Bone loss was more pronounced in patients within 24 months post-stroke and correlated with poorer muscle strength and motor recovery.
- Hip bone density and tibial diaphysis changes were minimal and within precision limits.
Conclusions:
- Continuous trabecular bone loss occurs in the paretic tibia post-stroke, plateauing around 2 years.
- Bone loss in the hip and tibial diaphysis may stabilize earlier.
- Findings highlight the need for targeted interventions to mitigate bone loss in stroke survivors.
Unlabelled:
The study aimed to quantify the long-term effects of stroke on tibial bone morphology and hip bone density. Only the trabecular bone mineral density and bone strength index in the hemiparetic tibial distal epiphysis showed a significant decline among individuals who had sustained a stroke 12-24 months ago.
Introduction:
This study aims to determine the changes in bone density and morphology in lower limb long bones during a 1-year follow-up period and their relationship to muscle function in chronic stroke patients.
Methods:
Twenty-eight chronic stroke patients (12-166 months after the acute stroke event at initial assessment) and 27 controls underwent bilateral scanning of the hip and tibia using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Each subject was re-assessed 1 year after the initial assessment.
Results:
Twenty stroke cases and 23 controls completed all assessments. At the end of the follow-up, the paretic tibial distal epiphysis suffered significant decline in trabecular bone density (-1.8 ± 0.6 %, p = 0.006) and bone strength index (-2.7 ± 0.6 %, p < 0.001). More severe decline in the former was associated with poorer leg muscle strength (ρ = 0.447, p = 0.048) and motor recovery (ρ = 0.489, p = 0.029) measured at initial assessment. The loss in trabecular bone density remained significant among those whose stroke onset was 12-24 months ago (p < 0.001), but not among those whose stroke onset was beyond 24 months ago (p > 0.05) at the time of initial assessment. The changes of outcomes in the tibial diaphysis, except for cortical bone mineral content on the non-paretic side (-1.3 ± 0.3 %, p = 0.003), and hip bone density were well within the margin of error for precision.
Conclusions:
There is evidence of continuous trabecular bone loss in the paretic tibial distal epiphysis among chronic stroke patients, but it tends to plateau after 2 years of stroke onset. The steady state may have been reached earlier in the hip and tibial diaphysis.
