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

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Abstract

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.

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Acknowledgments

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

Funding

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

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong

    F. Z. Yang, H. Ouyang & M. Y. C. Pang

  2. Department of Physical Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China

    F. Z. Yang & H. Ouyang

  3. Department of Physical Therapy, University of British Columbia, Vancouver, Canada

    D. A. M. Jehu

  4. Department of Medicine & Therapeutics, Chinese University of Hong Kong, Sha Tin, Hong Kong

    F. M. H. Lam

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  1. F. Z. Yang
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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.

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Correspondence to M. Y. C. Pang.

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Appendix

Appendix

Search strategy (MEDLINE)

  1. 1.

    Exp Cerebrovascular accident/

  2. 2.

    Exp Stroke/

  3. 3.

    Exp CVA/

  4. 4.

    Exp cerebral vascular/

  5. 5.

    Exp Brain injuries/

  6. 6.

    Exp Hemiplegia/

  7. 7.

    Exp Hemiplegic/

  8. 8.

    Or/1-7

  9. 9.

    Exp bone/ or Exp bone density/

  10. 10.

    Exp bone mineral density/

  11. 11.

    Exp bone geometry/

  12. 12.

    Exp bone strength/

  13. 13.

    Exp bone mass/

  14. 14.

    Exp bone volume /or Exp bone area/

  15. 15.

    Exp bone turnover/

  16. 16.

    Exp bone densitometry/

  17. 17.

    Or/ 9-17

  18. 18.

    Exp Dual-energy X-ray absorptiometry/or Exp DXA/or Exp DEXA

  19. 19.

    Exp Ultrasound/

  20. 20.

    Exp absorptiometry/

  21. 21.

    Exp peripheral quantitative computed tomography/or Exp PQCT/or Exp QCT/

  22. 22.

    Or/18-22

  23. 23.

    8 and 17 and 23

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Yang, F., Jehu, D.A.M., Ouyang, H. et al. The impact of stroke on bone properties and muscle-bone relationship: a systematic review and meta-analysis. Osteoporos Int 31, 211–224 (2020). https://doi.org/10.1007/s00198-019-05175-4

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