http://stroke.ahajournals.org/content/33/5/1432.short
Time to Think About Protection?
- Kenneth E.S. Poole, BM, MRCP;
- Jonathan Reeve, DM, BSc, FRCP;
- Elizabeth A. Warburton, MA, DM, MRCP
+ Author Affiliations
- Correspondence to Dr Elizabeth A. Warburton, Department of Stroke Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Box 83, Cambridge CB2 2QQ, UK. E-mail eaw23@medsch1.cam.ac.uk
Abstract
Background—
Osteoporosis is a significant complication of stroke. The clinical
course of hemiplegic stroke predisposes patients to disturbed
bone physiology. Sudden immobility and
unilateral loss of function unload the skeleton at key areas such as the
affected hip.
This is manifest by an early reduction in bone
density at this site. Stroke patients may also have motor, sensory, and
visual/perceptual
deficits that predispose them to falls. These
factors result in an early but sustained increase in hip fractures after
stroke.
Summary of Comment—
Potential bone loss is often overlooked in stroke treatment. Morbidity
and mortality from hip fractures might be reduced
by preventing bone loss at an early stage. In
the crucial first year after stroke, bone loss seems to be due to
accelerated
resorption. Bisphosphonates are the drugs of
choice in preventing osteoclastic bone resorption, but oral
administration soon
after stroke may be impractical. Potent new
intravenous bisphosphonates have been used in postmenopausal women with
osteoporosis
with good preliminary results. Effective dosing
regimens for osteoporosis have included a single annual or semiannual
injection
of bisphosphonate as well as weekly oral dosing.
This article reviews the current literature on osteoporosis and hip
fractures
after stroke, making a case for a trial of
intravenous bisphosphonates early after stroke.
Conclusions—
Hip fracture after stroke is an increasingly recognized problem.
Measures to prevent bone loss and preserve bone architecture
have not been part of stroke management thus
far. Because rapid bone loss is a risk factor for fracture, we believe
that a
randomized, placebo-controlled trial of
intravenous bisphosphonates given in the early phase of stroke
rehabilitation is indicated.
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