Key characteristics of walking correlate with bone density in individuals with chronic stroke.

Several recent studies of ambulatory stroke survivors have shown decreased bone mineral density (BMD) in the lower limbs and an elevated risk of hip fracture. Because bone mass is linked to skeletal loading, weight-bearing activities of daily living such as walking are considered critically important for maintenance of femoral BMD in ambulatory individuals. Little is known about the relationships between walking characteristics, skeletal loading, and bone maintenance in individuals who have experienced a stroke. This study determined whether certain gait-related parameters correlate with proximal femoral BMD in ambulatory individuals with poststroke walking deficits. We analyzed data from 33 individuals with chronic stroke and found that a recently introduced metric, the Bone Density Index, which incorporates body weight, number of steps per day, and ground reaction force magnitude, predicted proximal femoral BMD better than other commonly measured demographic and gait-related parameters that we examined.

[1]  J. Zuckerman,et al.  Effect of previous cerebrovascular accident on outcome after hip fracture. , 2000, Journal of orthopaedic trauma.

[2]  G S Beaupré,et al.  An approach for time‐dependent bone modeling and remodeling—theoretical development , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[3]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[4]  R T Whalen,et al.  Influence of physical activity on the regulation of bone density. , 1988, Journal of biomechanics.

[5]  C. Horne,et al.  Effects of Exercise on Bone Density, Balance, and Self-Efficacy in Older Women , 2003, Biological research for nursing.

[6]  J. Eng,et al.  Magnitude and pattern of 3D kinematic and kinetic gait profiles in persons with stroke: relationship to walking speed. , 2004, Gait & posture.

[7]  T. Wilsgaard,et al.  Walking after Stroke: Does It Matter? Changes in Bone Mineral Density Within the First 12 Months after Stroke. A Longitudinal Study , 2000, Osteoporosis International.

[8]  R. Prince,et al.  Forearm bone loss in hemiplegia: A model for the study of immobilization osteoporosis , 1988, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[9]  R. Whalen,et al.  Physical Activity and Bone Density in Women , 2000 .

[10]  G. Blake,et al.  Different approaches to bone densitometry. , 2000, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[11]  Robert B. Salter,et al.  Skeletal Function and Form. Mechanobiology of Skeletal Development, Aging, and Regeneration. , 2001 .

[12]  Günes Yavuzer,et al.  Bone mineral density in patients with stroke , 2002, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[13]  G. Mulley,et al.  Hip fracture after hemiplegia. , 1979, Postgraduate medical journal.

[14]  B. Resnick,et al.  Measurement of Activity in Older Adults: Reliability and Validity of the Step Activity Monitor , 2001, Journal of Nursing Measurement.

[15]  An assessment of osteoporosis in stroke patients on rehabilitation admission , 2004, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[16]  D A Boone,et al.  Step activity monitor: long-term, continuous recording of ambulatory function. , 1999, Journal of rehabilitation research and development.

[17]  H. Ucan,et al.  Bone Mineral Density in Patients with Stroke , 2001, American journal of physical medicine & rehabilitation.

[18]  A. Ramnemark,et al.  Stroke, a major and increasing risk factor for femoral neck fracture. , 2000, Stroke.

[19]  A. Ramnemark,et al.  Progressive Hemiosteoporosis on the Paretic Side and Increased Bone Mineral Density in the Nonparetic Arm the First Year after Severe Stroke , 1999, Osteoporosis International.

[20]  O. Johnell,et al.  Acute and Long-Term Increase in Fracture Risk After Hospitalization for Stroke , 2001, Stroke.

[21]  AndersOdén,et al.  Acute and Long-Term Increase in Fracture Risk After Hospitalization for Stroke , 2001 .

[22]  JoAnne K. Gronley,et al.  Classification of walking handicap in the stroke population. , 1995, Stroke.

[23]  J. Shaw,et al.  Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[24]  S. G. Nelson,et al.  Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. , 1983, Physical therapy.

[25]  T P Andriacchi,et al.  Walking speed as a basis for normal and abnormal gait measurements. , 1977, Journal of biomechanics.

[26]  T. Ogihara,et al.  Alterations of bone mineral density of the femurs in hemiplegia , 1995, Calcified Tissue International.

[27]  Compliance with physical activity recommendations by walking for exercise--Michigan, 1996 and 1998. , 2000, MMWR. Morbidity and mortality weekly report.

[28]  Jonathan Reeve,et al.  Falls, Fractures, and Osteoporosis After Stroke: Time to Think About Protection? , 2002, Stroke.

[29]  A. Puente,et al.  Determinants of bone mineral density in immobilization: A study on hemiplegic patients , 2005, Osteoporosis International.

[30]  O. Rutherford,et al.  Hip bone mineral density is improved by high-impact aerobic exercise in postmenopausal women and men over 50 years , 2006, European Journal of Applied Physiology and Occupational Physiology.

[31]  A. Ramnemark,et al.  Fractures after Stroke , 1998, Osteoporosis International.

[32]  Claus Christiansen,et al.  Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. , 1994, World Health Organization technical report series.

[33]  C. Granger,et al.  Interrater reliability of the 7-level functional independence measure (FIM) , 1994, Scandinavian journal of rehabilitation medicine.

[34]  T. Tsuji,et al.  Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-ray absorptiometry. , 1999, Archives of physical medicine and rehabilitation.

[35]  M. Peszczynski The fractured hip in hemiplegic patients. , 1957, Geriatrics.