Yoo Seung Don, Kim Tae-Woo, Oh Byung-Mo, Lee Seung Ah, Kim Chanwoo, Chung Ho Yeon, Son Jung Eun, Lee Ji Yeon, Lee Hyunji, Lee Hoo Young
Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Medicine, AgeTech-Service Convergence Major, Kyung Hee University, Seoul, Korea.
Ann Rehabil Med. 2024 Dec;48(6):413-422. doi: 10.5535/arm.240079. Epub 2024 Dec 20.
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.
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.
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).
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.
为了确定偏瘫性脑卒中患者脊柱与髋部之间以及患侧与健侧髋部之间T值不一致的患病率及相关因素，本研究调查了骨密度（BMD）模式。中风后骨质流失主要影响患侧髋部，而使用双能X线吸收法（DXA）对腰椎（LS）和单髋进行扫描的典型临床评估可能会忽略骨质疏松症的诊断。这种疏忽可能会导致中风患者的治疗效果欠佳。
本研究是一项多中心回顾性分析，对2014年10月至2022年2月期间因中风康复入院的540例患者进行了腰椎和双侧髋部的DXA检查。
腰椎与髋部之间一致性、低腰椎不一致性和低髋部不一致性的患病率分别为48.2%、12.2%和39.6%。双侧髋部之间的不一致率为17.0%。患侧全髋T值显著低于健侧（p<0.001）。值得注意的是，患侧髋部低不一致性在慢性期更为普遍。与腰椎和单髋DXA扫描相比，腰椎和双侧髋部的DXA扫描显示主要不一致性高0.7%-0.9%。多变量分析显示，患侧髋部低不一致性与认知障碍之间存在显著相关性（调整后的优势比为0.071，95%置信区间为0.931-1.003，p<0.05）。
由于中风幸存者髋部骨折风险较高，对于中风后骨质疏松症的护理，应考虑进行包括腰椎和双侧髋部在内的全面骨密度评估，以提高诊断准确性并及时治疗。
