Paker Nurdan, Bugdayci Derya, Tekdos Demet, Dere Caglayan, Kaya Betul
Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey.
J Stroke Cerebrovasc Dis. 2009 Mar-Apr;18(2):139-43. doi: 10.1016/j.jstrokecerebrovasdis.2008.09.013.
To investigate the relationship between the rate of bone turnover and bone loss at the proximal femur in stroke patients.
This study was performed between January 1, 2005 and August 31, 2006 at the Stroke Rehabilitation Unit, Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey. One hundred six patients who had a stroke for the first time were included in the study. The control group consisted of 33 age- and gender-matched healthy subjects. Bone mineral density (BMD) was measured at the proximal hip region by dual energy X-ray absorptiometry (DXA). Serum osteocalcin (OC) and C telopeptide of type 1 collagen (CTX) levels were measured. Barthel Index (BI) was used for the evaluation of daily activities. Ambulation status of the patients was recorded.
Mean age was 65.1 +/- 9.8 years in the patient group and 51% were male. Mean disease duration was 16.9 +/- 9.1 months. Mean BI score was 60.5 +/- 25.8 on admission. Femoral neck BMD values were 0.873 +/- 0.95 g/cm(2) and 0.816 +/- 0.180 g/cm(2) for control subjects and hemiplegic sides of the patient group, respectively. Femur total BMD values were 0.948 +/- 0.119 g/cm(2) and 0.872 +/- 0.187 g/cm(2) for control group and hemiplegic sides of the patients, respectively. Femoral neck and femur total BMD values in the hemiplegic side were lower than those of controls' (P < .05). There was no statistically significant difference between the proximal femur BMD values of the intact and hemiplegic sides. Negative correlation was found between the proximal femur BMD values of both the intact and hemiplegic sides, and serum OC and CTX levels. Bone resorption rate was higher among the patients with stroke; however, bone formation rate was normal in this group. Serum CTX levels showed correlation with ambulation status. Femoral neck BMD values on the intact side were lower in the patient group with disease duration of more than 1 year compared to those with shorter disease duration.
As a result of this study bone turnover was inversely correlated with bone density at the hip of both hemiplegic and intact sides in stroke patients. Evaluation of bone turnover might be helpful to predict bone loss and to find out the stroke patients with bone loss who can not be decided to begin antiresorptive treatment with bone density measurement.
探讨中风患者股骨近端骨转换率与骨质流失之间的关系。
本研究于2005年1月1日至2006年8月31日在土耳其伊斯坦布尔物理医学与康复训练医院的中风康复科进行。106例首次中风患者纳入研究。对照组由33名年龄和性别匹配的健康受试者组成。采用双能X线吸收法（DXA）测量近端髋部区域的骨密度（BMD）。检测血清骨钙素（OC）和I型胶原C末端肽（CTX）水平。采用Barthel指数（BI）评估日常活动能力。记录患者的行走状态。
患者组平均年龄为65.1±9.8岁，男性占51%。平均病程为16.9±9.1个月。入院时平均BI评分为60.5±25.8。对照组和患者组偏瘫侧的股骨颈BMD值分别为0.873±0.95 g/cm²和0.816±0.180 g/cm²。对照组和患者组偏瘫侧的股骨总BMD值分别为0.948±0.119 g/cm²和0.872±0.187 g/cm²。偏瘫侧的股骨颈和股骨总BMD值低于对照组（P <.05）。健侧和偏瘫侧的股骨近端BMD值之间无统计学显著差异。健侧和偏瘫侧的股骨近端BMD值与血清OC和CTX水平呈负相关。中风患者的骨吸收速率较高；然而，该组的骨形成速率正常。血清CTX水平与行走状态相关。病程超过1年的患者组健侧的股骨颈BMD值低于病程较短的患者组。
本研究结果表明，中风患者偏瘫侧和健侧髋部的骨转换与骨密度呈负相关。评估骨转换可能有助于预测骨质流失，并找出无法通过骨密度测量决定是否开始抗吸收治疗的骨质流失中风患者。
