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. 2022 Sep;8(3):106-111.
doi: 10.1016/j.afos.2022.08.001. Epub 2022 Sep 21.

Changes in bone mineral density in unconscious immobile stroke patients from the acute to chronic phases of brain diseases

Shoko Merrit Yamada  1
Affiliations

Changes in bone mineral density in unconscious immobile stroke patients from the acute to chronic phases of brain diseases

Shoko Merrit Yamada. Osteoporos Sarcopenia. 2022 Sep.

Abstract

Objectives: Decreased bone mineral density (BMD) is observed in immobile stroke patients. But it is not clarified yet how rapidly BMD reduction occurs or what the most influencing factor to BMD loss is.

Methods: BMDs in the lumbar vertebrae and the proximal femur of the paralyzed side were measured in 100 immobile stroke patients at 1 week (0 month), 1 month, and 2 months after admission. The levels of serum calcium, phosphorous, 25-hydroxyvitamin D, and urine cross-linked N-telopeptide of type I collagen (NTx) were also measured.

Results: The average age of patients was 75.0 ± 11.4 years (31-94 years). No BMD reduction was identified in the lumbar vertebrae in 2 months; however, BMD in the femur significantly decreased in 2 months in female patients (P < 0.05). Serum calcium and phosphorous levels remained within the normal range during hospitalization, and 25-hydroxyvitamin D value rose in 2 months. Urine NTx significantly increased in both males and females in 2 months (male: P < 0.05, female: P < 0.01).

Conclusions: While there was no significant change in lumbar spine BMD in the 2 month period of immobilization after stroke, BMD in the proximal femur showed a significant reduction, particularly in women. The differential loss of BMD in the 2 regions of interest could possibly be due to the physical forces acting on different body parts during mobilization and nutritional factors. More studies are needed with larger study samples and prolonged follow-up to check the accuracy of these observations.

Keywords: Bone mineral density; Femur; Immobilization; Load; Osteoporosis.

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Figures

Fig. 1
Fig. 1
Changes in BMD of the lumbar vertebrae and femoral bone. On admission, BMD was significantly lower in females than males in both the lumbar vertebrae and femoral bone (P < 0.05). (A) Lumbar BMD gradually increased in both males and females, but there were no significant differences among 0, 1, and 2 months (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, P > 0.05). (B) On the contrary, femoral BMD gradually decreased in both males and females. In males, there were no significant differences among 0, 1, and 2 months (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, P < 0.05). However, in females, BMD at 2 months was significantly lower than that on admission (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, ∗P < 0.05).
Fig. 2
Fig. 2
Changes in serum calcium and phosphorus. The normal range of serum calcium is 8.6–10.2 mg/dl and that of serum phosphorus is 2 limit compared with that on admission. 5–4.6 mg/mL. (A) Serum calcium was constant at the lower normal limit compared with that on admission (0 month vs 1 month, P > 0.05; 1 month vs. 2 months, P > 0.05; 0 month vs. 2 months, P > 0.05). (B) Serum phosphorous increased gradually, and was significantly higher at 2 months than that on admission in both males (0 month vs 1 month, P > 0.05; 1 month vs 2 months, ∗P < 0.05; 0 month vs 2 months, ∗P < 0.05) and females (0 month vs. 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, ∗P < 0.05) without exceeding the normal range.
Fig. 3
Fig. 3
Changes in serum 25-OH vitamin D. The lower normal limit of serum 25-OH vitamin D is 20 ng/mL, although maintenance of ≥ 30 ng/mL is encouraged for healthy bone. In both males and females, 25-OH vitamin D was lower than the lower normal limit. And particularly in female, the value is significantly lower than in male on admission (P < 0.05). However, the concentration gradually increased during admission. In males, there were no significant differences among 0, 1, and 2 months (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, P > 0.05), but the level reached 20 ng/mL at 2 months. In females, serum 25-OH vitamin D was significantly higher at 2 months than that on admission (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, ∗P < 0.05), although the concentration did not reach the lower normal limit.
Fig. 4
Fig. 4
Changes in serum NTx and urine NTx. The normal range of serum NTx is 9.5–17.7 nM BCE/L in males and 10.7–24.0 nM BCE/L in post-menopausal females, while that of urine NTx is 13.0–66.2 nM BCE/mM•Cr in males and 14.3–89.0 nM BCE/mM•Cr in post-menopausal females. (A) Serum NTx was higher than the upper normal limit in both males and females from 0 to 2 months, and constantly higher in females than in males. The level clearly increased at 2 months, but there were no significant differences among 0, 1, and 2 months in both males and females (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, P > 0.05). (B) Urine NTx was markedly increased in both males and females, and reached more than twice the upper normal limit at 2 months. In males, the level at 2 months was significantly higher than that on admission (0 month vs 1 month, P > 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, ∗P < 0.05). In females, the level increased rapidly and was significantly higher at 1 month than that on admission (0 month vs 1 month, ∗P < 0.05; 1 month vs 2 months, P > 0.05; 0 month vs 2 months, ∗∗P < 0.01).
Fig. 5
Fig. 5
Correlation between decrease of BMD and increase of urine NTx. In both male and female, negative correlation was identified between decrease of BMD and increase of urine NTx. Pearson's correlation coefficient (r) was −0.613 in male (A) and −0.652 in female (B) demonstrating moderately strong correlation.
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