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Bone metabolism in hemiplegic patients.

C Van Ouwenaller¹, D Uebelhart, A Chantraine

¹Division de Médecine physique, Universitaire de Genève, Switzerland.

Scandinavian Journal of Rehabilitation Medicine

|January 1, 1989

Summary

Hemiplegic patients exhibit neurologic osteoporosis due to an active bone metabolism imbalance. This condition appears linked to venous stasis, impacting bone resorption and potentially causing osteoporosis.

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Area of Science:

Orthopedics
Neurology
Metabolic Bone Disease

Background:

Hemiplegic patients, resulting from cerebrovascular accidents (CVA) or head injuries, can develop secondary bone complications.
Understanding the specific mechanisms of bone metabolism alterations in hemiplegia is crucial for effective management.

Purpose of the Study:

To investigate bone metabolism in hemiplegic patients.
To identify the relationship between neurological injury, bone changes, and circulatory factors.

Main Methods:

Assessed 36 hemiplegic patients (18-77 years) using serum calcium, phosphorus, and hydroxyprolinuria tests.
Utilized radiological examination, single photon absorptiometry, bone scans (99mTc), and 47Ca kinetic studies.
Determined intramedullary pressure and performed intraosseous phlebography.

Main Results:

Elevated serum calcium, phosphorus, and hydroxyprolinuria observed in the first month.
Radiological signs of demineralization and increased bone scan hypercaptation in paralyzed limbs.
Increased urinary and fecal calcium excretion; bone resorption initially high, decreasing after 12 months.
Bone accretion generally normal, with higher values in younger patients.

Conclusions:

Neurologic osteoporosis in hemiplegia is characterized by an imbalance between bone synthesis and degradation.
Venous stasis, indicated by intramedullary pressure and phlebography, is a likely contributor to bone resorption.
Circulatory modifications may influence cell differentiation, contributing to hemiplegic osteoporosis.

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