Changes in bone mineral density in unconscious immobile stroke patients from the acute to chronic phases of brain diseases

다국어 초록 (Multilingual Abstract)

Objectives: Decreased bone mineral density (BMD) is observed in immobile stroke patients. But it is not clarified yet how rapidly BMD reduction occurs or what the most influencing factor to BMD loss is.
Methods: BMDs in the lumbar vertebrae and the proximal femur of the paralyzed side were measured in 100 immobile stroke patients at 1 week (0 month), 1 month, and 2 months after admission. The levels of serum calcium, phosphorous, 25-hydroxyvitamin D, and urine cross-linked N-telopeptide of type I collagen (NTx) were also measured.
Results: The average age of patients was 75.0 ± 11.4 years (31-94 years). No BMD reduction was identified in the lumbar vertebrae in 2 months; however, BMD in the femur significantly decreased in 2 months in female patients (P < 0.05). Serum calcium and phosphorous levels remained within the normal range during hospitalization, and 25-hydroxyvitamin D value rose in 2 months. Urine NTx significantly increased in both males and females in 2 months (male: P < 0.05, female: P < 0.01).
Conclusions: While there was no significant change in lumbar spine BMD in the 2 month period of immobilization after stroke, BMD in the proximal femur showed a significant reduction, particularly in women. The differential loss of BMD in the 2 regions of interest could possibly be due to the physical forces acting on different body parts during mobilization and nutritional factors. More studies are needed with larger study samples and prolonged follow-up to check the accuracy of these observations.

참고문헌 (Reference)

1 Jørgensen L, "Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study" 11 : 381-387, 2000

2 Kuno H, "Vitamin D status and nonhemiplegic bone mass in patients following stroke" 45 : 257-263, 1998

3 Bouillon R, "Vitamin D insufficiency : definition, diagnosis and management" 32 : 669-684, 2018

4 Shinchuk LM, "Vitamin D deficiency and osteoporosis in rehabilitation inpatients" 87 : 904-908, 2006

5 Timpini A, "Vitamin D and health status in elderly" 6 : 11-21, 2011

6 Nachemson AL, "The load on lumbar disks in the different positions of the body" 45 : 107-122, 1966

7 Vellas B, "The Mini Nutritional Assessment(MNA)and its use in grading the nutritional state of elderly patients" 15 : 116-122, 1999

8 Iwamoto J, "Sunlight exposure is important for preventing hip fractures in patients with Alzheimer's disease, Parkinson's disease, or stroke" 125 : 279-284, 2012

9 Rohlmann A, "Spinal loads during position changes" 27 : 754-758, 2012

10 Makhsous M, "Sitting with adjustable ischial and back supports : biomechanical changes" 28 : 1113-1121, 2003

11 Rodríguez-Martínez MA, "Role of Ca(2þ)and vitamin D in the prevention and treatment of osteoporosis" 93 : 37-49, 2002

12 Brown DL, "Risk of fractures after stroke" 25 : 95-99, 2008

13 Kim HW, "Prevalence of pre-stroke low bone mineral density and vertebral fracture in first stroke patients" 43 : 183-186, 2008

14 Wyskida M, "Prevalence and factors promoting the occurrence of vitamin D deficiency in the elderly" 71 : 198-204, 2017

15 Schousboe JT, "Prediction of hip osteoporosis by DXA using a novel pulse-echo ultrasound device" 28 : 85-93, 2017

16 Liu M, "Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry" 80 : 1219-1226, 1999

17 Carda S, "Osteoporosis after stroke : a review of the causes and potential treatments" 28 : 191-200, 2009

18 Pirlich M, "Nutrition in the elderly" 15 : 869-884, 2001

19 Alajlouni D, "Nonstandard lumbar region in predicting fracture risk" 21 : 220-226, 2018

20 Andersson BJ, "Lumbar disc pressure and myoelectric back muscle activity during sitting. I. Studies on an experimental chair" 6 : 104-114, 1974

21 Hamdy RC, "Long-term effects of strokes on bone mass" 74 : 351-356, 1995

22 Orimo H, "Japanese 2011guidelines for prevention and treatment of osteoporosiseexecutive summary" 7 : 3-20, 2012

23 Thomsen K, "Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis?" 26 : 1459-1475, 2015

24 Faulkner KG, "Implications in the use of T-scores for the diagnosis of osteoporosis in men" 5 : 87-93, 2002

25 Dennis MS, "Fractures after stroke : frequency, types, and associations" 33 : 728-734, 2002

26 Ramnemark A, "Fractures after stroke" 8 : 92-95, 1998

27 Baxter I, "Evaluation of urinary N-telopeptide of type I collagen measurements in the management of osteoporosis in clinical practice" 24 : 941-947, 2013

28 Iwamoto J, "Early changes in urinary cross-linked N-terminal telopeptides of type I collagen level correlate with 1-year response of lumbar bone mineral density to alendronate in postmenopausal Japanese women with osteoporosis" 23 : 238-242, 2005

29 Blake GM, "Dual X-ray absorptiometry of the lumbar spine : the precision of paired anteroposterior/lateral studies" 67 : 624-630, 1994

30 Nachemson AL, "Disc pressure measurements" 6 : 93-97, 1981

31 del Puente A, "Determinants of bone mineral density in immobilization : a study on hemiplegic patients" 6 : 50-54, 1996

32 Pacheco EM, "Detection of osteoporosis by dual energy X-ray absorptiometry(DXA)of the calcaneus : is the WHO criterion applicable?" 70 : 475-482, 2002

33 Saarelainen J, "Cross-calibration of GE healthcare lunar prodigy and iDXA dual-energy X-ray densitometers for bone mineral measurements" 2016 : 1424582-, 2016

34 Fall PM, "Comparison of serum and urine assays for biochemical markers of bone resorption in postmenopausal women with and without hormone replacement therapy and in men" 11 : 481-485, 2000

35 Tani Y, "Combined effects of eating alone and living alone on unhealthy dietary behaviors, obesity and underweight in older Japanese adults : results of the JAGES" 95 : 1-8, 2015

36 Gennari C, "Calcium and vitamin D nutrition and bone disease of the elderly" 4 : 547-559, 2001

37 Yavuzer G, "Bone mineral density in patients with stroke" 25 : 235-239, 2002

38 Van Ouwenaller C, "Bone metabolism in hemiplegic patients" 21 : 165-170, 1989

39 Garnero P, "Bone markers in osteoporosis" 7 : 84-90, 2009

40 Bainbridge NJ, "Bone loss after stroke over 52 weeks at os calcis : influence of sex, mobility and relation to bone density at other sites" 35 : 127-132, 2006

41 Garnero P, "Biomarkers for osteoporosis management : utility in diagnosis, fracture risk prediction and therapy monitoring" 12 : 157-170, 2008

42 Szulc P, "Biochemical markers of bone turnover : potential use in the investigation and management of postmenopausal osteoporosis" 19 : 1683-1704, 2008

43 Sato Y, "Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients" 61 : 338-342, 2003

44 Takamoto S, "Alterations of bone mineral density of the femurs in hemiplegia" 56 : 259-262, 1995