Atan Tugba, Ekinci Umay, Uran San Ayca, Demir Yasin, Guzelkucuk Umut, Kesikburun Serdar, Uyar Koylu Sinem, Tan Arif Kenan
Gaziler Physical Therapy And Rehabilitation Training And Research Hospital, University of Health Sciences, Ankara, Turkey.
PM R. 2025 May;17(5):529-538. doi: 10.1002/pmrj.13290. Epub 2024 Nov 27.
Poststroke osteoporosis, particularly of the hip, and an increased risk of fractures due to accidental falls are well known in people with stroke. Only a few of the current stroke guidelines recommend bone mineral density (BMD) measurements during follow-up in this population and measurements are often performed unilaterally.
To compare femoral hip BMD between fallers and nonfallers among patients with stroke, while also assessing differences in balance, mobility, fear of falling, and exploring discrepancies between paretic and nonparetic sides within each group.
Cross-sectional.
Inpatient stroke rehabilitation unit of a tertiary university hospital.
Patients with unilateral hemiplegia hospitalized as a result of stroke.
Not applicable.
The primary outcome was the femoral neck BMD measurement. Dual-energy x-ray absorptiometry was used to measure BMD. Secondary outcomes included Berg balance scale (BBS), timed up-and-go test (TUGT), functional ambulation classification (FAC), and falls efficacy scale-international (FES-I).
A total of 44 patients were enrolled. Twenty-two participants (50%) reported falling. There were no statistically significant differences in BMD (p = .504, p = .197, p = .667, respectively) and T-scores (p = .457, p = .194, p = .693, respectively) of paretic, nonparetic femoral neck, and lumbar spine between nonfallers and fallers. The BBS (p = .033, 95% confidence interval [CI] 0.17-19.05) was significantly lower in the fallers. The FES-I was statistically significantly higher in the fallers (p = .001, 95% CI -22.40 to -6.50). The BMD and T-scores of femoral neck between the paretic and the nonparetic limbs did not differ significantly in the nonfallers (n = 22) (p = .908, 95% CI -0.03-0.03; p = .886, 95% CI -0.27-0.24) but did differ in the fallers (n = 22) (p = .007, 95% CI -0.06 to -0.01; p = .006, 95% CI -0.51 to -0.09).
This study emphasizes that hip BMD may differ on paretic and nonparetic sides, especially in patients with stroke and a history of falls and balance problems. Fall-related self-efficacy and balance may be determinants of falls in these patients.
中风后骨质疏松，尤其是髋部骨质疏松，以及中风患者因意外跌倒导致骨折的风险增加，这是众所周知的。目前只有少数中风指南建议在该人群的随访期间进行骨密度（BMD）测量，而且测量通常是单侧进行的。
比较中风患者中跌倒者与未跌倒者的股骨髋部骨密度，同时评估平衡、活动能力、跌倒恐惧方面的差异，并探讨每组中患侧与非患侧之间的差异。
横断面研究。
一所三级大学医院的住院中风康复科。
因中风住院的单侧偏瘫患者。
不适用。
主要结局是股骨颈骨密度测量。采用双能X线吸收法测量骨密度。次要结局包括伯格平衡量表（BBS）、计时起立行走测试（TUGT）、功能性步行分类（FAC）和国际跌倒效能量表（FES-I）。
共纳入44例患者。22名参与者（50%）报告有跌倒经历。未跌倒者与跌倒者在患侧、非患侧股骨颈及腰椎的骨密度（分别为p = 0.504、p = 0.197、p = 0.667）和T值（分别为p = 0.457、p = 0.194、p = 0.693）方面无统计学显著差异。跌倒者的BBS（p = 0.033，95%置信区间[CI] 0.17 - 19.05）显著更低。跌倒者的FES-I在统计学上显著更高（p = 0.001，95% CI -22.40至-6.50）。在未跌倒者（n = 22）中，患侧与非患侧肢体的股骨颈骨密度和T值无显著差异（p = 0.908，95% CI -0.03 - 0.03；p = 0.886，95% CI -0.27 - 0.24），但在跌倒者（n = 22）中存在差异（p = 0.007，95% CI -0.06至-0.01；p = 0.006，95% CI -0.51至-0.09）。
本研究强调髋部骨密度在患侧与非患侧可能存在差异，尤其是在有跌倒史和平衡问题的中风患者中。与跌倒相关的自我效能和平衡可能是这些患者跌倒的决定因素。
