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Muscle weakness, spasticity and disuse contribute to demineralization and geometric changes in the radius following chronic stroke

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Abstract

Summary

Bone health status of the radius in individuals with chronic stroke was evaluated using peripheral quantitative computed tomography. Bone mineral density and cortical thickness on the affected side were compromised when compared with the unaffected side. Muscle weakness, spasticity, and disuse were identified as contributing factors to such changes.

Introduction

Following a stroke, demineralization and geometric changes occur in bone as a result of disuse and residual impairments, and these can contribute to an increased risk of fragility fractures.

Methods

This study used peripheral quantitative computed tomography (pQCT) to evaluate volumetric bone mineral density and geometry at the midshaft radius in people living with chronic stroke. Older individuals with chronic stroke were recruited. Each subject underwent a pQCT scan of the midshaft radius at the 30% site on both upper limbs. Muscle strength, motor function, spasticity, and chronic disuse were also evaluated. Data from 47 subjects (19 women) were assessed.

Results

A significant difference was found between the two limbs for cortical bone mineral content, cortical bone mineral density, cortical thickness, and polar stress-strain index. There was no significant side-to-side difference in total bone area. Percent side-to-side difference in muscle strength, spasticity, and chronic disuse were significant determinants of percent side-to-side difference in cortical bone mineral content and cortical thickness.

Conclusions

The findings suggest that following chronic stroke, endosteal resorption of the midshaft radius occurred with a preservation of total bone area. Muscle weakness, spasticity, chronic disuse significantly contributed to demineralization and geometric changes in the radius following chronic stroke.

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References

  1. Wolf SL, Lecraw DE, Barton LA et al (1989) Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurology 104:125–132

    Article  CAS  Google Scholar 

  2. Hamdy RC, Krishnaswamy G, Cancellaro V et al (1993) Changes in bone mineral content and density after stroke. Am J Phys Med Rehabil 72:188–191

    Article  PubMed  CAS  Google Scholar 

  3. Prince RL, Price RI, Ho S (1988) Forearm bone loss in hemiplegia: a model for the study of immobilization osteoporosis. J Bone Miner Res 3:305–310

    PubMed  CAS  Google Scholar 

  4. Liu M, Tsuji T, Higuchi Y et al (1999) Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry. Arch Phys Med Rehabil 80:1219–1226

    Article  PubMed  CAS  Google Scholar 

  5. Ramnemark A, Nyberg L, Lorentzon R et al (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 

  6. Kanis J, Oden A, Johnell O (2001) Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke 32:702–706

    PubMed  CAS  Google Scholar 

  7. Ramnemark A, Nyberg L, Borssen B et al (1998) Fractures after stroke. Osteoporos Int 8:92–95

    Article  PubMed  CAS  Google Scholar 

  8. Dennis MS, Lo KM, McDowall M et al (2002) Fractures after stroke. Frequency, types and associations. Stroke 33:728–734

    Article  PubMed  CAS  Google Scholar 

  9. Garrett NA, Brasure M, Schmitz KH et al (2004) Physical inactivity. Direct cost to a Health Plan. Am J Prev Med 27:304–309

    PubMed  Google Scholar 

  10. Jorgensen 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

    PubMed  CAS  Google Scholar 

  11. Pang MYC, Eng JJ (2005) Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: implications for stroke rehabilitation. Bone 37:103–111

    Article  PubMed  Google Scholar 

  12. Iwamoto J, Takeda T, Ichimura S (2001) Relationships between physical activity and metacarpal cortical bone mass and bone resorption in hemiplegic patients. J Orthop Sci 6:227–233

    Article  PubMed  CAS  Google Scholar 

  13. Sahin L, Ozoran K, Gunduz OH et al (2001) Bone mineral density in patients with stroke. Am J Phys Med Rehabil 80:592–596

    Article  PubMed  CAS  Google Scholar 

  14. Sato Y, Fujimatsu Y, Kikuyama M et al (1998) Influence of immobilization on bone mass and bone metabolism in hemiplegic elderly patients with long-standing stroke. J Neurol Sci 156:205–210

    Article  PubMed  CAS  Google Scholar 

  15. Frost HM (2003) Absorptiometry and “osteoporosis”: problems. J Bone Miner Metab 21:255–260

    Article  PubMed  Google Scholar 

  16. Burr DB, Turner Ch (2003) Biomechanics of bone. In: Favus MJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism, 5th edn. American Society for Bone and Mineral Research, Washington DC, pp 58–64

    Google Scholar 

  17. Ashe MC, Fehling P, Eng JJ et al (in press) Bone structural changes to chronic disuse following stroke. J Musculoskelet and Neuron Interact

  18. Riggs LB, Melton LJ, Robb RA et al (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 

  19. Pang MYC, Eng JJ, Dawson AS et al (2005) A community-based Fitness and Mobility Exercise program for older adults with chronic stroke: a randomized controlled trial. J Am Geriatr Soc 53:1667–1674

    Article  PubMed  Google Scholar 

  20. Folstein MF, Folstein, SE, McHugh PR (1975) Mini-mental state: a practical method for grading the state of patients for the clinician. J Psychiat Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  21. Kelly-Hayes M, Robertson JT, Broderick JP et al (1998) The American Heart Association Stroke Outcome Classification: executive summary. Circulation 97:2474–2478

    PubMed  CAS  Google Scholar 

  22. Liu-Ambrose TY, Khan KM, Eng JJ et al (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom 7:390–398

    Article  PubMed  Google Scholar 

  23. Pang MYC, Ashe MC, Eng JJ et al (2006) A 19-week exercise program for people with chronic stroke enhances bone geometry at the tibia: a peripheral quantitative computed tomography study. Osteoporos Int 17:1615–1625

    Article  PubMed  CAS  Google Scholar 

  24. Fess EE (1992) Grip strength. In: Casanova JS (ed) Clinical assessment recommendations, 2nd edn. American Society of Hand Therapists, Chicago, pp 41–45

    Google Scholar 

  25. McCrea PH, Eng JJ, Hodgson AJ (2003) Time and magnitude of torque generation is impaired in both arms following stroke. Muscle Nerve 28:46–53

    Article  PubMed  Google Scholar 

  26. Bohannon RW (1997) Measurement and nature of muscle strength in patients with stroke. J Neuro Rehabil 11:115–125

    Google Scholar 

  27. Mathiowetz V (2002) Comparison of Rolyan and Jamar dynamometers for measuring grip strength. Occup Ther Int 9:201–209

    Article  PubMed  Google Scholar 

  28. Wolf SL, Catlin PA, Ellis M et al (2001) Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke. Stroke 32:1635–1639

    PubMed  CAS  Google Scholar 

  29. Morris DM, Uswatte G, Crago JE et al (2001) The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 82:750–755

    Article  PubMed  CAS  Google Scholar 

  30. Bohannon BW, Smith MB (1987) Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Phys Ther 67:206–207

    PubMed  CAS  Google Scholar 

  31. van der Lee JH, Beckerman H, Knol DL et al (2004) Clinimetric properties of the Motor Activity Log for the assessment of arm use in hemiparetic patients. Stroke 35:1410–1414

    Article  PubMed  Google Scholar 

  32. Hughes VA, Frontera WR, Dallal GE et al (1995) Muscle strength and body composition: associations with bone density in older subjects. Med Sci Sports Exerc 27:967–974

    Article  PubMed  CAS  Google Scholar 

  33. Di Monaco M, Di Monaco R, Manca M et al (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 

  34. Eser P, Schiessl H, Willnecker J (2004) Bone loss and steady state after spinal cord injury: a cross-sectional study using pQCT. J Musculoskel Neuron Interact 4:197–198

    CAS  Google Scholar 

  35. Russo CR, Laurentani F, Bandinelli S et al (2003) Aging bone in men and women: beyond changes in bone mineral density. Osteoporos Int 14:531–538

    Article  PubMed  CAS  Google Scholar 

  36. Ahlborg HG, Johnell O, Turner CH et al (2003) Bone loss and bone size after menopause. New Engl J Med 349:327–334

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  38. Adami S, Gatti D, Braga V et al (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 

  39. Wilmet E, Ismail AA, Heilporn A et al (1995) Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section. Paraplegia 33:674–677

    PubMed  CAS  Google Scholar 

  40. Taub E, Miller NE, Novack TA et al (1993) Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 74:347–354

    PubMed  CAS  Google Scholar 

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Funding

MYCP was supported by a post-doctoral fellowship from Natural Sciences and Engineering Research Council of Canada. MCA was supported by a post-doctoral fellowship from the Michael Smith Foundation for Health Research. This study was supported by a grant-in-aid from the Heart Stroke Foundation of British Columbia and Yukon (JJE), and from career scientist awards from Canadian Institute of Health Research (JJE) and the Michael Smith Foundation for Health Research (JJE).

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Authors and Affiliations

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

    M. Y. C. Pang

  2. School of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada

    M. Y. C. Pang, M. C. Ashe & J. J. Eng

  3. Rehabilitation Research Laboratory, GF Strong Centre, Vancouver, BC, Canada

    M. Y. C. Pang, M. C. Ashe & J. J. Eng

  4. Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    M. Y. C. Pang, M. C. Ashe & J. J. Eng

Authors
  1. M. Y. C. Pang
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  2. M. C. Ashe
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  3. J. J. Eng
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Corresponding author

Correspondence to M. Y. C. Pang.

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Pang, M.Y.C., Ashe, M.C. & Eng, J.J. Muscle weakness, spasticity and disuse contribute to demineralization and geometric changes in the radius following chronic stroke. Osteoporos Int 18, 1243–1252 (2007). https://doi.org/10.1007/s00198-007-0372-6

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  • DOI: https://doi.org/10.1007/s00198-007-0372-6

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