Skip to main content

Advertisement

SpringerLink
Log in

Relative impact of neuromuscular and cardiovascular factors on bone strength index of the hemiparetic distal radius epiphysis among individuals with chronic stroke

  • Original
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The objective of this study was to examine the associations of neuromuscular and cardiovascular impairments with the bone strength index of the hemiparetic distal radius epiphysis in chronic stroke survivors. The results showed that grip strength is the most predominant predictor of the bone strength index.

Introduction

The pupose of the study was to examine the associations of neuromuscular and cardiovascular impairments with the bone strength index of the hemiparetic distal radius epiphysis in chronic stroke survivors.

Methods

Sixty-five chronic stroke survivors and 34 healthy control subjects underwent scanning of the distal radius epiphyseal site on both sides using peripheral quantitative computed tomography to measure trabecular volumetric bone mineral density (vBMD) (mg/cm3), total vBMD (mg/cm3), total area (mm2), and compressive bone strength index (cBSI) (g2/cm4). Various indicators of neuromuscular (grip strength, spasticity) and cardiovascular function (vascular elasticity, oxygen consumption during 6-min walk test) were evaluated.

Results

Analysis of variance revealed a significant main effect of side (p < 0.001) and group × side interaction (p < 0.05) for total BMC, total vBMD, trabecular vBMD, and cBSI (p < 0.05), with the stroke group showing greater side-to-side difference in these variables. However, no significant side-to-side difference in total area was detected in either group (p > 0.05). Sex-specific analysis yielded similar results. Multiple regression analyses revealed that the cBSI of the hemiparetic distal radius epiphysis had a stronger association with neuromuscular factors than cardiovascular factors. Overall, grip strength was the strongest determinant of the cBSI of the hemiparetic distal radius epiphysis (p < 0.01).

Conclusions

Muscle weakness is the most predominant determinant of cBSI in the hemiparetic distal radius epiphysis among chronic stroke patients. Future studies should investigate the efficacy of different muscle-strengthening strategies in enhancing bone strength of this skeletal site in the chronic stroke population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dennis MS, Lo KM, McDowall M, West T (2002) Fractures after stroke: frequency, types, and associations. Stroke 33:728–734

    Article  PubMed  CAS  Google Scholar 

  2. Ramnemark A, Nyberg L, Lorentzon R, Englund U, Gustafson Y (1999) Progressive hemiosteoporosis on the paretic side and increased bone mineral density in the nonparetic arm the first year after severe stroke. Osteoporos Int 9:269–275

    Article  PubMed  CAS  Google Scholar 

  3. Jørgensen L, Jacobsen BK (2001) Functional status of the paretic arm affects the loss of bone mineral in the proximal humerus after stroke: a 1-year prospective study. Calcif Tissue Int 68:11–15

    Article  PubMed  Google Scholar 

  4. Ashe MC, Fehling P, Eng JJ, Khan KM, McKay HA (2006) Bone geometric response to chronic disuse following stroke: a pQCT study. J Musculoskelet Neuronal Interact 6:226–233

    PubMed  CAS  Google Scholar 

  5. Pang MYC, Ashe MA, Eng JJ (2007) Muscle weakness, spasticity and disuse contribute to demineralization and geometric changes in the radius following chronic stroke. Osteoporos Int 18:1243–1252

    Article  PubMed  CAS  Google Scholar 

  6. Lazoura O, Groumas N, Antoniadou E, Papadaki PJ, Papadimitriou A, Thriskos P, Fezoulidis I, Vlychou M (2008) Bone mineral density alterations in upper and lower extremities 12 months after stroke measured by peripheral quantitative computed tomography and DXA. J Clin Densitom 11:511–517

    Article  PubMed  Google Scholar 

  7. Pang MYC, Ashe MA, Eng JJ (2008) Tibial bone geometry in chronic stroke patients: influence of sex, cardiovascular health, and muscle mass. J Bone Miner Res 23:1023–1030

    Article  PubMed  Google Scholar 

  8. Pang MY, Ashe MC, Eng JJ (2010) Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity. Osteoporos Int 21:997–1007

    Article  PubMed  CAS  Google Scholar 

  9. Kopunek SP, Michael KM, Shaughnessy M, Resnick B, Nahm ES, Whitall J, Goldberg A, Macko RF (2007) Cardiovascular risk in survivors of stroke. Am J Prev Med 32:408–412

    Article  PubMed  Google Scholar 

  10. MacKay-Lyons MJ, Makrides L (2004) Longitudinal changes in exercise capacity after stroke. Arch Phys Med Rehabil 85:1608–1612

    Article  PubMed  Google Scholar 

  11. Whitney C, Warburton ER, Frohlich J, Chan SY, McKay H, Khan K (2004) Are cardiovascular disease and osteoporosis directly linked? Sports Med 34:779–807

    Article  PubMed  Google Scholar 

  12. Farhat GN, Cauley IA, Matthews KA, Newman AB, Johnston J, Mackey R, Edmundowicz D, Sutton-Tyrrell K (2006) Volumetric BMD and vascular calcification in middle-aged women: the study of women’s health across the nation. J Bone Miner Res 21:1839–1846

    Article  PubMed  Google Scholar 

  13. Naves M, Rodríguez-García M, Díaz-López JB, Gómez-Alonso C, Cannata-Andía JB (2008) Progression of vascular calcifications is associated with greater bone loss and increased bone fractures. Osteoporos Int 19:1161–1166

    Article  PubMed  CAS  Google Scholar 

  14. Griffith JF, Yeung DK, Tsang PH, Choi KC, Kwok TC, Ahuja AT, Leung KS, Leung PC (2008) Compromised bone marrow perfusion in osteoporosis. J Bone Miner Res 23:1068–1075

    Article  PubMed  Google Scholar 

  15. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS (1994) Recovery of upper extremity function in stroke patients: the Copenhagen stroke study. Arch Phys Med Rehabil 75:394–398

    Article  PubMed  CAS  Google Scholar 

  16. The Government of the Hong Kong Special Administrative Region (2011) Hong Kong Statistics. http://www.censtatd.gov.hk/hong_kong_statistics/statistical_tables/index.jsp?charsetID=1&tableID=139&subjectID=1. Accessed 20 October 2011

  17. Washburn RA, Smith KW, Jette AM, Janney CA (1993) The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162

    Article  PubMed  CAS  Google Scholar 

  18. Kontulainen S, Sievanen H, Kannus P, Pasanen M, Vuori L (2002) Effect of long-term impact-loading on mass, size, and estimated strength of humerus and radius of female racquet-sports players: a peripheral quantitative computed tomography study between young and old starters and controls. J Bone Miner Res 17:2281–2289

    Article  PubMed  Google Scholar 

  19. Macdonald HM, Kontulainen S, Petit M, Janssen P, McKay H (2006) Bone strength and its determinants in pre-and early pubertal boys and girls. Bone 39:598–608

    Article  PubMed  Google Scholar 

  20. Kontulainen SA, Johnston JD, Liu D, Leung C, Oxland TR, McKay HA (2008) Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact 8:401–409

    PubMed  CAS  Google Scholar 

  21. Di Monaco M, Di Monaco R, Manca M, Cavanna A (2000) Handgrip strength is an independent predictor of distal radius bone mineral density in postmenopausal women. Clin Rheumatol 19:473–476

    Article  PubMed  Google Scholar 

  22. Frank AW, Lorbergs AL, Chilibeck PD, Farthing JP, Kontulainen SA (2010) Muscle cross sectional area and grip torque contraction types are similarly related to pQCT derived bone strength indices in the radii of older healthy adults. J Musculoskelet Neuronal Interact 10:136–141

    PubMed  CAS  Google Scholar 

  23. De Zepetnek JOT, Craven BC, Giangregorio LM (2011) An evaluation of the muscle-bone unit theory among individuals with spinal cord injury. Spinal Cord. doi:10.1038/sc.2011.99

  24. Patten C, Lexell J, Brown HE (2004) Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy. J Rehabil Res Dev 41:293–312

    Article  PubMed  Google Scholar 

  25. Harris JE, Eng JJ (2007) Paretic upper-limb strength best explains arm activity in people with stroke. Phys Ther 87:88–97

    Article  PubMed  Google Scholar 

  26. Boissy P, Bourbonnais D, Carlotti MM, Gravel D, Arsenault BA (1999) Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function. Clin Rehabil 13:354–362

    Article  PubMed  CAS  Google Scholar 

  27. Watkins CL, Leathley MJ, Gregson JM, Moore AP, Smith TL, Sharma AK (2002) Prevalence of spasticity post stroke. Clin Rehabil 16:515–522

    Article  PubMed  CAS  Google Scholar 

  28. Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP, Rodgers H (1999) A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity. Clin Rehabil 13:373–383

    Article  PubMed  CAS  Google Scholar 

  29. Cameron JD, Rajkumar C, Kingwell BA, Jennings GL, Dart AM (1999) Higher systemic arterial compliance is associated with greater exercise time and lower blood pressure in a young older population. J Am Geriatr Soc 47:653–656

    PubMed  CAS  Google Scholar 

  30. Agabiti-Rosei E, Muiesan ML (2007) Carotid atherosclerosis, arterial stiffness and stroke events. Adv Cardiol 44:173–186

    Article  PubMed  CAS  Google Scholar 

  31. HDI Hypertension Diagnostics Inc (2005) HDI/PulseWaveTM CR-2000 Research cardiovascular profiling system manual. HDI Hypertension Diagnostics Inc, Eagan

    Google Scholar 

  32. Zimlichman R, Shargorodsky M, Boaz M, Duprez D, Rahn KH, Rizzoni D, Payeras AC, Hamm C, McVeigh G (2005) Determination of arterial compliance using blood pressure waveform analysis with the CR-2000: reliability, repeatability, and establishment of normal values for healthy European population—the seven European sites study (SESS). Am J Hypertens 18:65–71

    Article  PubMed  Google Scholar 

  33. Duprez DA, De Buyzere MM, De Bruyne L, Clement DL, Cohn JN (2001) Small and large artery elasticity indices in peripheral arterial occlusive disease (PAOD). Vasc Med 6:211–214

    Article  PubMed  CAS  Google Scholar 

  34. Wilson AM, O’Neal D, Nelson CL, Prior DL, Best JD, Jenkins AJ (2004) Comparison of arterial assessments in low and high vascular disease risk groups. Am J Hypertens 17:285–291

    Article  PubMed  Google Scholar 

  35. Syeda B, Gottsauner-Wolf M, Denk S, Pichler P, Khorsand A, Glogar D (2003) Arterial compliance: a diagnostic marker for atherosclerotic plaque burden? Am J Hypertens 16:356–362

    Article  PubMed  Google Scholar 

  36. Tang A, Sibley KM, Thomas SG, McIlroy WE, Brooks D (2006) Maximal exercise test results in subacute stroke. Arch Phys Med Rehabil 87:1100–1105

    Article  PubMed  Google Scholar 

  37. Nieman DC, Austin MD, Benezra L, Pearce S, McInnis T, Unick J, Gross SJ (2006) Validation of Cosmed's FitMate in measuring oxygen consumption and estimating resting metabolic rate. Res Sports Med 14:89–96

    PubMed  Google Scholar 

  38. Eng JJ, Dawson AS, Chu KS (2004) Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil 85:113–118

    Article  PubMed  Google Scholar 

  39. Riggs LB, Melton LJ III, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, Rouleau PA, McCollough CH, Bouxsein ML, Khosla S (2004) A population-based study of age and sex differences in bone volumetric density, size, geometry and structure at different skeletal sites. J Bone Miner Res 19:1945–1954

    Article  PubMed  Google Scholar 

  40. Schoenau E (2005) From mechanostat theory to development of the functional muscle-bone-unit. J Musculoskelet Neuronal Interact 5:232–238

    PubMed  CAS  Google Scholar 

  41. MacIntyre NJ, Rombough R, Brouwer B (2010) Relationships between calf muscle density and muscle strength, mobility and bone status in the stroke survivors with subacute and chronic lower limb hemiparesis. J Musculoskelet Neuronal Interact 10:249–255

    PubMed  CAS  Google Scholar 

  42. Colebatch JG, Gandevia SC (1989) The distribution of muscular weakness in upper motor neuron lesions affecting the arm. Brain 112:749–763

    Article  PubMed  Google Scholar 

  43. Michael KM, Allen JK, Macko RF (2005) Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil 86:1552–1556

    Article  PubMed  Google Scholar 

  44. Adami S, Gatti D, Braga V, Bianchini D, Rossini M (1999) Site-specific effects of strength training on bone structure and geometry of ultradistal radius in postmenopausal women. J Bone Miner Res 14:120–124

    Article  PubMed  CAS  Google Scholar 

  45. Hangartner TN, Gilsanz V (1996) Evaluation of cortical bone by computed tomography. J Bone Miner Res 11:1518–1525

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

AQC was supported by a Research Studentship provided by the Hong Kong Polytechnic University. This study was supported by research grants from the Hong Kong Polytechnic University (87-SK), and Research Grants Council (General Research Fund no. 525607, no. 526708).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China

    M. Y. C. Pang, A. Q. Cheng & A. Y. M. Jones

  2. Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, British Columbia, Canada

    D. E. Warburton

Authors
  1. M. Y. C. Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Q. Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. E. Warburton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Y. M. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Y. C. Pang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pang, M.Y.C., Cheng, A.Q., Warburton, D.E. et al. Relative impact of neuromuscular and cardiovascular factors on bone strength index of the hemiparetic distal radius epiphysis among individuals with chronic stroke. Osteoporos Int 23, 2369–2379 (2012). https://doi.org/10.1007/s00198-012-1899-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-012-1899-8

Keywords

Search

Navigation