Early upper and lower limbs bone microarchitecture alterations evaluated by HR-PQCT after stroke with hemiplegia

Stroke is the leading cause of acquired physical disability. In recent years, there has been a decline in early mortality due to acute medical care as well as better and earlier prevention of adverse events after stroke, therefore exposing more these patients to fragility fractures. We report very early assessment of bone microarchitecture changes in the first months following stroke-induced hemiplegia in a monocentric prospective study.

Patients had to be included within 15days of stroke and 2 follow-up visits were planned at 3 and 6months. At each time points, microarchitecture parameters were assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and the radius sites on both paretic and non-paretic sides. P-values were adjusted for multiple comparisons.

Ten patients were included. All were all right-handed, hemiplegia occurring on dominant side in 6 of them. Cortical thickness decreased from baseline on paretic side (PS) as early as 3months and 6months both at radius (P=0.031) and tibia (P=0.005), while it remained stable on non-paretic side (NPS). The radius cortical area also significantly decreased only on PS (P=0.049). There was an increase in Ct.Po on both sides over time, only at the tibia. No early changes in trabecular parameters were observed. As a result, failure load rapidly changed at both radial and tibial locations regardless of side, with numerically greater changes at the tibia PS.

Stroke-induced hemiplegia was associated with microarchitectural damages in both tibial and radial cortical envelopes regardless of body side, as early as 3months post-event. These results suggest the need for early bone loss prevention including pharmacologic treatments.