Beaupre Gary S, Lew Henry L
Bone and Joint Center of Excellence, VA Palo Alto Health Care System, Palo Alto 94304, and the Biomechanical Engineering, Stanford University, Stanford, California, USA.
Am J Phys Med Rehabil. 2006 May;85(5):464-72. doi: 10.1097/01.phm.0000214275.69286.7a.
It has been many years since bone loss and fracture risk were first recognized as serious complications of stroke. Hip fracture is associated with a substantial increase in morbidity and mortality for stroke survivors, and therefore, assessing and maintaining skeletal health after stroke should be an important clinical goal. Recent long-term, prospective studies have illustrated a highly nonuniform pattern of bone changes after stroke. In general, there is significant bone loss on the paretic side, which is greatest in those patients with the most severe functional deficits. In some patients, bone loss in the paretic arm during the first year after stroke is the equivalent of >20 yrs of bone loss in healthy individuals of comparable age. Bone density in the nonparetic upper limb can actually increase after stroke, consistent with an increase in habitual use of the nonparetic hand. Bone density in the paretic lower limb can decrease by >10% in <1 yr, with smaller decreases being typical for the nonparetic lower limb. Despite the recent increase in the number of prospective, longitudinal studies, important questions about bone changes after stroke remain unanswered. Longer-term studies quantifying bone loss for periods of >12 mos poststroke are needed to determine how long excess bone loss continues after stroke. Studies with more subjects and with more varied disability levels are needed to better understand the relationships between functional deficits and bone loss. New metrics are needed to quantify the intensity and duration of physical activity in the upper and lower limbs that are consistent with previous research on the role of mechanical stimuli in bone adaptation. Finally, an assessment of skeletal health and the factors that affect bone quantity and quality should be a standard component in the clinical management of all survivors of stroke.
自骨质流失和骨折风险首次被确认为中风的严重并发症以来，已经过去了许多年。髋部骨折与中风幸存者的发病率和死亡率大幅上升相关，因此，评估并维持中风后的骨骼健康应是一项重要的临床目标。近期的长期前瞻性研究表明，中风后骨骼变化的模式极不一致。一般来说，患侧存在明显的骨质流失，在功能缺损最严重的患者中最为明显。在一些患者中，中风后第一年患侧手臂的骨质流失相当于同龄健康个体20多年的骨质流失量。中风后，非患侧上肢的骨密度实际上可能会增加，这与非患侧手习惯性使用增加一致。患侧下肢的骨密度在不到1年的时间里可能会下降超过10%，而非患侧下肢通常下降幅度较小。尽管近期前瞻性纵向研究的数量有所增加，但关于中风后骨骼变化的重要问题仍未得到解答。需要进行更长时间的研究，对中风后超过12个月的骨质流失进行量化，以确定中风后骨质过度流失会持续多长时间。需要开展有更多受试者、残疾水平更多样化的研究，以更好地理解功能缺损与骨质流失之间的关系。需要新的指标来量化上肢和下肢身体活动的强度和持续时间，这些指标应与先前关于机械刺激在骨骼适应中作用的研究一致。最后，对骨骼健康以及影响骨量和骨质量的因素进行评估，应成为所有中风幸存者临床管理的标准组成部分。
