Changes to volumetric bone mineral density and bone strength after stroke: A prospective study

Authors

  • Karen Borschmann,

    Corresponding author
    1. School of Health Science, Latrobe University, Melbourne, Victoria, Australia
    2. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
    • Correspondence: Karen Borschmann, The Florey Institute of Neuroscience and Mental Health, 245 Burgundy St, Heidelberg, Victoria 3084, Australia.

      E-mail: karen.borschmann@florey.edu.au

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  • Marco Y. C. Pang,

    1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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  • Sandra Iuliano,

    1. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
    2. Endocrine Centre, Austin Health, Heidelberg, Victoria, Australia
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  • Leonid Churilov,

    1. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
    2. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
    3. Department of Mathematics and Statistics, University of Melbourne, Heidelberg, Victoria, Australia
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  • Amy Brodtmann,

    1. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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  • Elif I. Ekinci,

    1. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
    2. Endocrine Centre, Austin Health, Heidelberg, Victoria, Australia
    3. Menzies School of Health Research, Darwin, Northern Territory, Australia
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  • Julie Bernhardt

    1. School of Health Science, Latrobe University, Melbourne, Victoria, Australia
    2. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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  • Funding: This study is funded by the Australian Research Council (ARC-FT09901086), Austin Health Medical Research Fund and LaTrobe University Faculty Research Grant. EIE is supported by an NHMRC Early Career Fellowship (APP#APP1054312) and AB by an NHMRC Career Development Award.

Abstract

Rationale and aim

Stroke survivors experience accelerated bone loss and increased fracture risk, particularly in paretic weight bearing limbs. Understanding how these changes unfold and their relationship to stroke severity and physical activity could help in the development of targeted interventions to prevent or reduce the severity of these outcomes. The primary aim of this study is to investigate the time course and magnitude of changes in volumetric bone mineral density within the first year after stroke, and to examine relationships with physical activity and motor recovery.

Design

This is a prospective, observational study of 43 nondiabetic, nonambulant adults with first ever hemispheric stroke.

Primary outcome

The primary outcome was the difference in six-month change of total volumetric bone mineral density between paretic and nonparetic distal tibiae, measured at 7% of bone length site using high-resolution peripheral quantitative computed tomography.

Secondary outcomes

The secondary outcomes are cortical and trabecular volumetric bone mineral density, cortical thickness, and total and cross-sectional areas of distal tibiae and radii of paretic and nonparetic limbs. Also included are total body and regional bone mineral density derived using dual-energy X-ray absorptiometry, physical activity measured using accelerometry, and motor recovery (Chedoke McMaster Stroke Assessment).

Discussion

Measuring the timing and magnitude of changes to volumetric bone mineral density and bone structure from immediately after stroke, and relationships between these changes with physical activity and motor recovery will provide the basis for targeted interventions to reduce fracture risk in stroke survivors.

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