Background and purpose: It has been demonstrated that bone mineral density (BMD) is significantly reduced on the hemiplegic side of stroke patients and this might increase their risk of hip fracture. To elucidate the pathogenesis, and consequently the possible means of prevention and treatment of decreased BMD in this population, we measured BMD and serum markers of bone metabolism in the stroke patients early after the onset of hemiplegia (within 1 year) and afterwards. Methods: The study included 25 patients with paresis after stroke. BMD was measured by dual energy x ray absorptiometery at both proximal femurs. Sera were collected from all patients and from 10 age and sex matched controls. Sera were assayed for procollagen 1 carboxyterminal propeptide (PICP) and osteocalcin (bone formation markers), 25 hydroxy vitamin D (25 OHD), serum calcium and parathormone and urinary deoxypyridinoline (a bone resorption marker). Results: BMD was decreased on the affected side of both early and long term groups. Urinary deoxypyridinoline concentrations were significantly higher in early group than in the long term group. Osteocalcin and PICP were normal in both groups. Beside these bone turnover markers, serum calcium was increased only in the early group. While 25 OHD was decreased significantly in both groups than controls, no significant changes could be detected in parathormone levels. Multiple regression analysis identified Barthel index, degree of hemiplegia and illness duration as independent determinants of urinary deoxypyridinoline in the early group, whereas Barthel index, degree of hemiplegia, and serum calcium were determinants of urinary deoxypyridinoline in the long term group. There were statistically significant correlations between the Z score of the hemiplegic side and age, Barthel index, degree of hemplegia, illness duration, 25 OHD and urinary deoxypyridinoline in the early group and between the Z score and degree of hemiplegia and 25 OHD level in the long term group. Conclusions: Reduced BMD differs in pathogenesis between the early and long term stroke groups. These results suggested that in the early group increased bone resorption caused by immobilization was responsible for osteopenia on the hemiplegic side, whereas the degree of hemiplegia and 25 OHD level were the determinants of osteopenia in the long term group. Osteopenia could be prevented early after hemiplegia by intensive medical rehabilitation of the patients along with bisphosphonate supplementation.
(Egypt J. Neurol. Psychiat. Neurosurg., 2004, 41 (3) suppl.: 869-879).