The impact of stroke on bone properties and muscle-bone relationship: a systematic review and meta-analysis

  • F. Z. Yang
  • D. A. M. Jehu
  • H. Ouyang
  • F. M. H. Lam
  • M. Y. C. PangEmail author


To systematically review available evidence related to the characteristics of bone changes post-stroke and the relationship between various aspects of muscle function (e.g., strength, spasticity) and bone properties after stroke onset. An extensive online database search was undertaken (last search in January 2019). Articles that examined the bone properties in stroke patients were included. The quality of the studies was evaluated with the National Institutes of Health (NIH) Study Quality Assessment Tools. Publication bias of meta-analyses was assessed using the Egger’s regression asymmetry test. The selection and evaluation of the articles were conducted by two independent researchers. Fifty-nine studies were identified. In subacute and chronic stroke studies, the skeletal sites in the paretic limbs sustained a more pronounced decline in bone quality than did their counterparts in the non-paretic limbs. The rate of changes showed a decelerating trend as post-stroke duration increased, but the timing of achieving the steady rate differed across skeletal sites. The magnitude of bone changes in the paretic upper limb was more pronounced than the paretic lower limb. There was a strong relationship between muscle strength/mass and bone density/strength index. Muscle spasticity seemed to have a negative impact on bone integrity in the paretic upper limb, but its influence on bone properties in the paretic lower limb was uncertain. Substantial bone changes in the paretic limbs occurred particularly in the first few months after stroke onset. Early intervention, muscle strength training, and long-term management strategies may be important to enhance bone health post-stroke. This review has also revealed the knowledge gaps which should be addressed in future research.


Bone properties Muscle function Muscle spasticity Osteoporosis Stroke 



Feigo Zhenhui Yang was granted a full-time research studentship by the Hong Kong Polytechnic University.

Author contributions

Feigo Zhenhui Yang and Marco Pang: conception of the work; Feigo Zhenhui Yang, Deborah Jehu, Huixi Ouyang, and Freddy Lam: data collection; Feigo Zhenhui Yang, Deborah Jehu, Huixi Ouyang, and Freddy Lam: data analysis and interpretation; Feigo Zhenhui Yang: drafting of the article; Feigo Zhenhui Yang, Deborah Jehu, Huixi Ouyang, Freddy Lam, and Marco Pang: critical revision of the article and final approval of the version to be published.

Funding information

This study was supported substantially by the Research Grants Council (General Research Fund no. 151025/14M).

Compliance with ethical standards

Conflict of interest


Supplementary material

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation SciencesHong Kong Polytechnic UniversityKowloonHong Kong
  2. 2.Department of Physical TherapyGuangdong Provincial Work Injury Rehabilitation HospitalGuangzhouChina
  3. 3.Department of Physical TherapyUniversity of British ColumbiaVancouverCanada
  4. 4.Department of Medicine & TherapeuticsChinese University of Hong KongSha TinHong Kong

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