Promoting recovery in motor control and walking ability may reduce bone loss in paretic legs within six months of stroke — ASN Events
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Promoting recovery in motor control and walking ability may reduce bone loss in paretic legs within six months of stroke (#81)

Karen Borschmann 1 2 , Sandra Iuliano-Burns 3 , Ali Ghasem-Zadeh 3 , Marco YC Pang 4 , Julie Bernhardt 1 2
  1. Florey Neuroscience Institutes, Heidelberg, 3084, Australia
  2. School of Physiotherapy, LaTrobe University, Bundoora, Victoria, Australia
  3. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
  4. Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong

Aims: Exercise may preserve cortical bone of stroke-affected (paretic) legs at >1 year after stroke, yet little is known about post-stroke skeletal changes. We investigated the magnitude of skeletal change and relationships with physical activity and motor control within 6-months of stroke. We hypothesised that cortical thickness would reduce significantly more in paretic compared to non-paretic legs.

Method: A prospective observational study. Participants, medically stable and non-diabetic but unable to walk were assessed within two weeks of first stroke, then at 1, 3 and 6 months. Assessments: bone structure (primary outcome=cortical thickness) and volumetric BMD of both legs at the distal tibia (high resolution peripheral quantitative computed tomography, HR-pQCT), lean mass (dual energy absorptiometry), bone metabolism (osteocalcin, N-terminal propeptide of type 1 procollagen (P1NP), C-terminal telopeptide of type 1 collagen (CTX)), physical activity (number of times to stand-up, 8am-5pm, PAL2 accelerometer), motor control (Chedoke McMaster).

Results: 22/37 participants recruited had suitable images of both legs at baseline and 6-months for inclusion in primary analysis. People included were younger than those not included (66.0 (SD 12.1) years vs 75.3 years (SD 8.3), p=0.03). Those included= 40.9% females, National Institutes Health Stroke Scale 12.6 (SD 4.8).

Cortical thickness reduced more in paretic than non-paretic legs (mean difference= -3.9%, 95% CI (-6.2, -1.5), p=0.002). Cortical area (p=0.002) and mass (p=0.004) also reduced more in paretic legs. Less reduction in paretic leg cortical thickness occurred in people who regained independent walking (n=16) compared to those who did not (n=6) (median -0.02% (IQR -0.07, -0.003) vs -0.11% (-0.18, -0.06), p=0.02). Higher baseline physical activity was inversely associated with changes in bone metabolism: P1NP (r= -0.47, p=0.01), osteocalcin (r= -0.51, p=0.01) and CTX (r= -0.53, p=0.01).

Conclusion: Targeting rehabilitation to improving leg motor control and walking within 6-months of stroke may reduce paretic-leg bone loss.