N.Yu. Karpova, M.A. Rashid, I.V. Pogonchenkova

(1) sbei HPE RNSMU. N. And. Pirogov Of Rmph, Moscow; (2) SBHCI "City hospital № 56", Moscow
Osteoporosis after stroke is not only a medical, but also a significant socially problem. Additional fracture risk of bearing parts of the skeleton, particularly the proximal femur is associated with severe disability, high mortality of patients and a heavy financial burden for the national health system. The article highlights the pathogenic mechanisms of bone metabolism disorders, developing after stroke. The article demonstrates the role of the endocrine system, nutritive factors, degree of immobilization and concomitant drug therapy in the development of osteoporosis. We discuss the possible non-drug methods and medicines for the treatment of these patients.


  1. Beaupre G.S., Lew H.L. Bone-density changes after stroke. Am. J. Phys. Med. Rehabil. 2006;85(5):464–72.
  2. Hamdy R.C., Moore S.W., Cancellaro V.A., Harvill L.M. Long-term effects of strokes on bone mass. Am. J. Phys. Med. Rehabil. 1995;74:351–56.
  3. Dennis M.S., Lo K.M., McDowall M., West T. Fractures after stroke: frequency, types, and associations. Stroke. 2002;33:728–34.
  4. Ramnemark A., Nilsson M., Borssen B., Gustafson Y. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke. 2000;31:1572–77.
  5. Lazoura O., Groumas N., Antoniadou E., Papadaki P.J., Papadimitriou A., Thriskos P., Fezoulidis I., Vlychou M. Bone mineral density alterations in upper and lower extremities 12 months after stroke measured by peripheral quantitative computed tomography and DXA. J. Clin. Densitom. 2008;11:511–17.
  6. del Puente A., Pappone N., Mandes M.G., Mantova D., Scarpa R., Oriente P. Determinants of bone mineral density in immobilization: a study on hemiplegic patients. Osteoporos. Int. 1996;6:50–4.
  7. Takamoto S., Masuyama T., Nakajima M., Seikiya K., Kosaka H., Morimoto S., Ogihara T., Onishi T. Alterations of bone mineral density of the femurs in hemiplegia. Calcif. Tissue Int. 1995;56:259–62.
  8. Sato Y., Kuno H., Kaji M., Ohshima Y., Asoh T., Oizumi K. Increased bone resorption during the first year after stroke. Stroke. 1998;29:1373–77.
  9. Iversen E., Hassager C., Christiansen C. The effect of hemiplegia on bone mass and soft tissue body composition. Acta Neurol. Scand. 1989;79:155–59.
  10. Pang M.Y., Eng J.J. Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: implications for stroke rehabilitation. Bone. 2005;37:103–11.
  11. Paker N., Bugdayci D., Tekdos D., Dere C., Kaya B. Relationship between bone turnover and bone density at the proximal femur in stroke patients. J. Stroke. Cerebrovasc. Dis. 2009;18(2):139–43.
  12. Pluskiewicz W. Skeletal consequences in patients after stroke. Endokrynol. Pol. 2011;62(1):48–50.
  13. Brown D.L., Morgenstern L.B., Majersik J.J., Kleerekoper M., Lisabeth L.D. Risk of fractures after stroke. Cerebrovasc. Dis. 2008;25:95–99.
  14. Ramnemark A., Nyberg L., Borssen B., Olsson T., Gustafson Y. Fractures after stroke. Osteoporos. Int. 1998;8:92–5.
  15. Ramnemark A., Nilsson M., Borssen B., Gustafson Y. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke. 2000;31:1572–77.
  16. Kanis J., Oden A., Johnell O. Acute and longterm increase in fracture risk after hospitalization for stroke. Stroke. 2001;32:702–6.
  17. Jorgensen L., Engstad T., Jacobsen B.K. Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke 2002;33:542–47.
  18. Stewart A.F., Adler M., Byers C.M., Segre G.V., Broadus A.E. Calcium homeostasis in immobilization: an example of resorptive hypercalciuria. N. Engl. J. Med. 1982;306:1136–40.
  19. Sato Y., Kuno H., Asoh T., Honda Y., Oizumi K. Effect of immobilization on vitamin D status and bone mass in chronically hospitalized disabled stroke patients. Age Ageing. 1999;28:265–69.
  20. Pang M.Y., Ashe M.C., Eng J.J. Muscle weakness, spasticity and disuse contribute to demineralization and geometric changes in the radius following chronic stroke. Osteoporos. Int. 2007;18:1243–52.
  21. Worthen L.C., Kim C.M., Kautz S.A., Lew H.L., Kiratli B.J., Beaupre G.S. Key characteristics of walking correlate with bone density in individuals with chronic stroke. J. Rehabil. Res. Dev. 2005;42:761–68.
  22. Baer G., Smith M. The recovery of walking ability and subclassification of stroke. Physiother. Res. Int. 2001;6:135–44.
  23. Uluduz D., Adil M.M., Rahim B., Gilani W.I., Rahman H.A., Gilani S.I., Qureshi A.I. Vitamin D deficiency and osteoporosis in stroke survivors: an analysis of National Health and Nutritional Examination Survey (NHANES). J. Vasc. Interv. Neurol. 2014;7(1):23–8.
  24. Holick M.F. Vitamin D deficiency. N. Engl. J. Med. 2007;357:266–81.
  25. Shinchuk L.M., Morse L., Huancahuari N., Arum S,. Chen T.C., Holick M.F. Vitamin D deficiency and osteoporosis in rehabilitation inpatients. Arch. Phys. Med. Rehabil. 2006;87:904–08.
  26. Kim H.W., Kang E., Im S., Ko Y.J., Im S.A., Lee J.I. Prevalence of pre-stroke low bone mineral density and vertebral fracture in first stroke patients. Bone. 2008;43:183–86.
  27. Lanham-New S.A. Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proc. Nutr. Soc. 2008;67(2):163–76.
  28. Sato Y., Metoki N., Iwamoto J., Satoh K. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology. 2003;61:338–42.
  29. Marsden J., Gibson L.M., Lightbody C.E., Shar-ma A.K., Siddiqi M., Watkins C. Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence. Age Ageing. 2008;37(2):142–50.
  30. Szulc P., Arlot M., Chapuy M.C., Duboeuf F., Meunier P.J., Delmas P.D. Serum undercarboxylated steocalcin correlates with hip bone mineral density in elderly women. J. Bone Miner. Res. 1994;9:1591–95.
  31. Sato Y., Kuno H., Kaji M., Saruwatari N., Oizumi K. Effect of ipriflavone on bone in elderly hemiplegic stroke patients with hypovitaminosis D. Am. J. Phys. Med. Rehabil. 1999;78:457–63.
  32. van Meurs J.B., Dhonukshe-Rutten R.A., Pluijm S.M., van der Klift M., de Jonge R., Lindemans J., de Groot L.C., Hofman A., Witteman J.C., van Leeuwen J.P., Breteler M.M., Lips P., Pols H.A., Uitterlinden A.G. Homocysteine levels and the risk of osteoporotic fracture. N. Engl. J. Med. 2004;350:2033–41.
  33. Sato Y., Honda H., Iwamoto J., Kanoko T., Satoh K. Effect of folate and mecobalamin on hip fractures in patients with stroke. JAMA. 2005;293:1082–88.
  34. Cheng H.Y. The association of warfarin use with osteoporotic fracture in elderly patients with atrial fibrillation. Arch. Intern. Med. 2006;166:1525, author reply 1525.
  35. Andress D.L., Ozuna J., Tirschwell D., Grande L., Johnson M., Jacobson A.F., Spain W. Antiepileptic drug-induced bone loss in young male patients who have seizures. Arch. Neurol. 2002;59:781–86.
  36. Farhat G., Yamout B., Mikati M.A., Demirjian S., Sawaya R., El-Hajj Fuleihan G. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology. 2002;58:1348–53.
  37. Adams H.P.J., del Zoppo G., Alberts M.J., et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–711.
  38. Pettila V., Leinonen P., Markkola A., Hiilesmaa V., Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb. Haemost. 2002;87:182–96.
  39. Yaturu S., Bryant B., Jain S: Thiazolidinediones treatment decreases bone mineral density in type 2 diabetic men. Diabetes Care. 2007;30:1574–76.
  40. Tideiksaar R. Falls in Older People: Prevention & Management, Fourth Ed. (Essential Falls Management). Paperback, 2010.
  41. Sato Y., Honda Y., Kuno H., Oizumi K. Menatetrenone ameliorates osteopenia in disuseaffected limbs of vitamin D- and K-deficient stroke patients. Bone 1998;23:291–96.
  42. Sato Y., Asoh T., Kaji M, Oizumi K. Beneficial effect of intermittent cyclical etidronate therapy in hemiplegic patients following an acute stroke. J. Bone. Miner. Res. 2000;15:2487–94.
  43. Ikai T., Uematsu M., Eun S.S., Kimura C, Hasegawa C., Miyano S. Prevention of secondary osteoporosis postmenopause in hemiplegia. Am. J. Phys. Med. Rehabil. 2001;80:169–74.
  44. Sato Y., Iwamoto J., Kanoko T., Satoh K. Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke. Arch. Intern. Med. 2005;165:1743–48.
  45. Poole K.E., Loveridge N., Rose C.M., Warbur-ton E.A., Reeve J. A single infusion of zoledronate prevents bone loss after stroke. Stroke. 2007;38:1519–25.
  46. Reid I.R. Cardiovascular effects of calcium supplements. Nutrients. 2013;5(7):2522–29.
  47. Маличенко С.Б., Колосова И.Р. Профилактика и лечение первичного остеопороза у лиц пожилого возраста. Справочник поликлинического врача, 2005;2.
  48. Shiraishi A., Higashi S., Ohkawa H., et al. Преимущества альфакальцидола перед витамином D при лечении остеопороза. Международный эндокринологический журнал. 2010;7(31).
  49. Шахт Е., Риши Ф., Режинстер Д.В. Влияние альфакальцидола на прочность костной ткани, мышечную силу, риск падений и переломов. РМЖ. http://www.rmj.ru/articles_6546.htm
  50. Poole K.E., Reeve J., Warburton E.A. Falls, fractures, and osteoporosis after stroke: time to think about protection? Stroke. 2002;33:1432–36.
  51. National Osteoporosis Foundation (NOF): Clinician’s guide to prevention and treatment of osteoporosis. 2008. http://www.nof. org/professionals/NOF_Clinicians_Guide. pdf (accessed February 12, 2009).

About the Autors

N. Yu. Karpov – sbei HPE RNSMU. N. And. Pirogov of rmph; e-mail: karpovany@mail.ru
M. A. Rashid – GBUZ "City hospital № 56", Moscow
I. V. Pogonicheva – GBUZ "City hospital № 56", Moscow

Similar Articles

Бионика Медиа