BMD may differ on paretic and nonparetic sides in stroke patients with issues of falls and balance: Study

A new study published in the Journal of Physical Medicine and Rehabilitation found that in stroke patients with previous instances of falls and balance issues, bone mineral density (BMD) may vary on the paretic and nonparetic sides. 90% of stroke survivors have some functional difficulties, such as muscular weakness, discomfort, stiffness, cognitive dysfunction, poor balance, and frequent falls. Stroke is one of the primary causes of long-term disability. Reduced exercise and sedentary lifestyles brought on by these impairments may result in subsequent reductions in function and disability status.

It is generally recognized that stroke patients have a higher risk of fractures from unintentional falls and post-stroke osteoporosis, especially of the hip. Bone mineral density (BMD) measures are frequently taken unilaterally, and only a small number of the most recent stroke recommendations advise doing so throughout follow-up in this cohort. Tugba Atan and colleagues undertook this study to compare the femoral hip BMD of stroke patients who fall vs those who do not, as well as to evaluate variations in balance, mobility, and fear of falling, and to investigate differences between paretic and nonparetic sides within each group.

The inpatient stroke rehabilitation unit of a tertiary university hospital was the subject of this cross-sectional investigation. The primary subjects of the study were hospitalized stroke patients with unilateral hemiplegia. The femoral neck BMD measurement was the main result. BMD was measured by dual-energy x-ray absorptiometry. Functional ambulation classification (FAC), timed up-and-go test (TUGT), Berg balance scale (BBS), and falls efficacy scale-international (FES-I) were examples of secondary outcomes.

A total of 44 patients were enrolled. 50% of the volunteers, or 22, reported falling. The BMD and T-scores of the paretic, nonparetic femoral neck, and lumbar spine did not differ statistically significantly between fallers and non-fallers. Among the fallers, the BBS was considerably lower (p =.033, 95% CI 0.17-19.05). Statistically, the fallers had a considerably greater FES-I.

In the non-fallers (n = 22), there was no significant difference in the BMD and T-scores of the femoral neck between the paretic and nonparetic limbs (p =.908, 95% CI -0.03-0.03; p =.886, 95% CI -0.27-0.24), but there was a difference in the fallers. Overall, this study highlights that hip BMD can vary between paretic and nonparetic sides, particularly in stroke patients who have experienced falls and balance issues in the past. 

Reference:

Atan, T., Ekinci, U., Uran San, A., Demir, Y., Guzelkucuk, U., Kesikburun, S., Uyar Koylu, S., & Tan, A. K. (2024). The relationship between falls and hip bone mineral density of paretic and nonparetic limbs after stroke. In PM&R. Wiley. https://doi.org/10.1002/pmrj.13290