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Increased bone resorption during the first year after stroke
1Department of Neurology, Kurume University Medical Center, Japan. y-sato@ktarn.or.jp
Insights
Stroke survivors experience bone density loss on the affected side. Early bone loss is linked to increased resorption from immobilization, while later loss is influenced by hemiplegia severity and vitamin D levels.
Area of Science:
- Orthopedics
- Neurology
- Metabolic Bone Disease
Background:
- Stroke frequently leads to significant bone mineral density (BMD) reduction on the hemiplegic side.
- Understanding the mechanisms behind this bone loss is crucial for preventing fractures in stroke survivors.
Purpose of the Study:
- To investigate the pathogenesis of reduced BMD in stroke patients with hemiplegia.
- To compare bone metabolism markers and BMD in early (within 1 year) and long-term (1-2 years) post-stroke groups.
Main Methods:
- Serum samples from 51 early and 93 long-term hemiplegic stroke patients were analyzed.
- Bone resorption marker (pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen - ICTP) and bone formation marker (bone Gla protein) were measured.
- Bone mineral density (BMD) z scores were determined in the second metacarpals.
Main Results:
- Serum ICTP levels were significantly higher in the early group compared to the long-term group.
- Multiple regression identified factors like Barthel Index and hemiplegia severity influencing ICTP in both groups.
- Significant correlations were found between BMD z scores and various factors including illness duration, Barthel Index, 25-hydroxyvitamin D (25-OHD), and ICTP.
Conclusions:
- The pathogenesis of osteopenia differs between early and long-term stroke phases.
- In the early phase, immobilization-induced bone resorption is a key factor.
- In the long-term phase, hemiplegia severity and 25-OHD levels are primary determinants of osteopenia.
Background And Purpose:
Significant bone mineral density (BMD) reduction occurs in stroke patients on the hemiplegic side compared with the intact side. To elucidate the pathogenesis of hip fractures in this population, we measured serum markers of bone metabolism and BMD in the stroke patients within 1 year (early group) and between 1 and 2 years after onset of hemiplegia (long-term group).
Methods:
Sera were collected from 51 patients from the early group and 93 patients from the long-term group. All patients had hemiplegia. Sera were assayed for pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker) and bone Gla protein (a bone formation marker). The z score of BMD was determined in both second metacarpals.
Results:
Serum ICTP concentrations (ng/mL) were higher in the early group (15.4+/-4.1) than in the long-term group (6.7+/-4.4). Bone Gla protein was normal or low in both groups. Multiple regression analysis identified Barthel Index, degree of hemiplegia, and illness duration as independent determinants of ICTP in the early group, whereas Barthel Index, degree of hemiplegia, and serum calcium were determinants of ICTP in the long-term group. There were statistically significant correlations between the z score of the hemiplegic side and age, Barthel Index, degree of hemiplegia, illness duration, 25-hydroxyvitamin D (25-OHD), and ICTP in the early group and between the z score and degree of hemiplegia and 25-OHD level in the long-term group.
Conclusions:
The pathogenesis of reduced BMD differed between the early and long-term stroke groups. These results suggest that in the early group, increased bone resorption caused by immobilization was responsible for osteopenia on the hemiplegic side, whereas the degree of hemiplegia and 25-OHD level were the determinants of osteopenia in the long-term group.