Discordance Between Spine-Hip and Paretic-Nonparetic Hip Bone Mineral Density in Hemiplegic Stroke Patients: A Multicenter Retrospective Study
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Objective: To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.Methods: This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.Results: The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p<0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%–0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931–1.003, p<0.05).Conclusion: Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.
Abstract
Objective: To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.Methods: This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.Results: The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p<0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%–0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931–1.003, p<0.05).Conclusion: Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.
참고문헌 (38)
- Takamoto S, "Alterations of bone mineral density of the femurs in hemiplegia", Calcif Tissue Int, 56, pp.259~262 (1995)
- Jørgensen L, "Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study", Osteoporos Int, 11, pp.381~387 (2000)
- Lee HY, "Does hip bone density differ between paretic and non-paretic sides in hemiplegic stroke patients? and its relationship with physical impairment", J Bone Metab, 27, pp.237~246 (2020)
- Ramnemark A, "Stroke, a major and increasing risk factor for femoral neck fracture", Stroke, 31, pp.1572~1577 (2000)
- Jung SH, "Stroke rehabilitation fact sheet in Korea", Ann Rehabil Med, 46, pp.1~8 (2022)
- Kapral MK, "Risk of fractures after stroke : results from the Ontario stroke registry", Neurology, 88, pp.57~64 (2017)
- Yang FZ, "The impact of stroke on bone properties and muscle-bone relationship : a systematic review and meta-analysis", Osteoporos Int, 31, pp.211~224 (2020)
- Carda S, "Osteoporosis after stroke : a review of the causes and potential treatments", Cerebrovasc Dis, 28, pp.191~200 (2009)
- Kanis J, "Acute and long-term increase in fracture risk after hospitalization for stroke", Stroke, 32, pp.702~706 (2001)
- Kanis JA, "Diagnosis of osteoporosis and assessment of fracture risk", Lancet, 359, pp.1929~1936 (2002)
- Bonnick SL, "Right and left proximal femur analyses : is there a need to do both?", Calcif Tissue Int, 58, pp.307~310 (1996)
- Chen W, "Dual hip DXA. Is it time to change standard protocol?", J Clin Densitom, 25, pp.20~23 (2022)
- Baim S, "Precision assessment and radiation safety for dual-energy X-ray absorptiometry : position paper of the International Society for Clinical Densitometry", J Clin Densitom, 8, pp.371~378 (2005)
- Wong JC, "The diagnostic role of dual femur bone density measurement in low-impact fractures", Osteoporos Int, 14, pp.339~344 (2003)
- Ikegami S, "Unilateral vs bilateral hip bone mineral density measurement for the diagnosis of osteoporosis", J Clin Densitom, 17, pp.84~90 (2014)
- Afzelius P, "Dual-energy X-ray absorptiometry of both hips helps appropriate diagnosis of low bone mineral density and osteoporosis", Diagnostics(Basel), 7, pp.41~ (2017)
- Schwarz P, "Bone mineral density difference between right and left hip during ageing", Eur Geriatr Med, 2, pp.82~86 (2011)
- Glowacki J, "Discordance in femoral neck bone density in subjects with unilateral hip osteoarthritis", J Clin Densitom, 13, pp.24~28 (2010)
- Lopes JB, "Effect of the bilateral hip bone density measurement on clinical practice in elderly subjects", Maturitas, 63, pp.257~260 (2009)
- Cole RE, "Improving clinical decisions for women at risk of osteoporosis : dual-femur bone mineral density testing", J Am Osteopath Assoc, 108, pp.289~295 (2008)
- Jeremiah MP, "Diagnosis and management of osteoporosis", Am Fam Physician, 92, pp.261~268 (2015)
- Woodson G, "Dual X-ray absorptiometry T-score concordance and discordance between the hip and spine measurement sites", J Clin Densitom, 3, pp.319~324 (2000)
- Lee KJ, "T-score discordance of bone mineral density in patients with atypical femoral fracture", J Bone Joint Surg Am, 99, pp.1683~1688 (2017)
- Leslie WD, "Spine-hip discordance and fracture risk assessment : a physician-friendly FRAX enhancement", Osteoporos Int, 22, pp.839~847 (2011)
- Moayyeri A, "Discordance in diagnosis of osteoporosis using spine and hip bone densitometry", BMC Endocr Disord, 5, pp.3~ (2005)
- Hong AR, "Metabolic characteristics of subjects with spine-femur bone mineral density discordances : the Korean National Health and Nutrition Examination Survey(KNHANES 2008-2011)", J Bone Miner Metab, 37, pp.835~843 (2019)
- Kanis JA, "The diagnosis of osteoporosis", J Bone Miner Res, 9, pp.1137~1141 (1994)
- Li J, "The pathogenesis of post-stroke osteoporosis and the role oxidative stress plays in its development", Front Med(Lausanne), 10, pp.1256978~ (2023)
- Benzinger P, "Risk of osteoporotic fractures following stroke in older persons", Osteoporos Int, 26, pp.1341~1349 (2015)
- Salo S, "Association between bone mineral density and lumbar disc degeneration", Maturitas, 79, pp.449~455 (2014)
- Cummings SR, "Clinical use of bone densitometry : scientific review", JAMA, 288, pp.1889~1897 (2002)
- Frost HM, "Bone’s mechanostat : a 2003 update", Anat Rec A Discov Mol Cell Evol Biol, 275, pp.1081~1101 (2003)
- Schoenau E, "From mechanostat theory to development of the"Functional Muscle-Bone-Unit"", J Musculoskelet Neuronal Interact, 5, pp.232~238 (2005)
- Burr DB, "Effects of biomechanical stress on bones in animals", Bone, 30, pp.781~786 (2002)
- Ehrlich PJ, "The effect of in vivo mechanical loading on estrogen receptor alpha expression in rat ulnar osteocytes", J Bone Miner Res, 17, pp.1646~1655 (2002)
- Tan SD, "Inhibition of osteocyte apoptosis by fluid flow is mediated by nitric oxide", Biochem Biophys Res Commun, 369, pp.1150~1154 (2008)
- Bansod YD, "Computational analysis of bone remodeling in the proximal tibia under electrical stimulation considering the piezoelectric properties", Front Bioeng Biotechnol, 9, pp.705199~ (2021)
- Borschmann K, "Exercise protects bone after stroke, or does it? A narrative review of the evidence", Stroke Res Treat, 2012, pp.103697~ (2012)
