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Stroke survivors have brittler bones, more likely to fracture

DALLAS, May 3 Doctors may need to add treatment for osteoporosis to stroke rehabilitation therapy, according to a report in todays Stroke: Journal of the American Heart Association.

Osteoporosis is a deterioration of bone. Healthy bone goes through a natural cycle that balances the breakdown of old bone tissue and the manufacture of new bone. The breakdown occurs more quickly in osteoporosis, resulting in weak and brittle bones. Several studies have shown that regional osteoporosis of a limb paralyzed by stroke occurs rapidly after immobilization. More widespread osteoporosis occurs later.

"Osteoporosis is a significant complication of stroke," says Kenneth Poole, BM, MRCP, Stroke Registrar and clinical fellow at the Medical Research Council in the United Kingdom. "When someone is put to bed and has an immobilized limb, the cells that break down bone are overactive."

In a review of several studies on osteoporosis and hip fracture after stroke, Poole and his colleagues report that one Swedish study shows hip fracture was two to four times more likely in stroke patients than in an age-matched reference population. Another study reported a more than four-fold increased risk of hip fracture for stroke survivors in the immediate post stroke period compared with the general Swedish population.

In Pooles report, researchers who investigated the mechanisms of osteoporotic fracture in older people found that most fractures in stroke patients occur on the side paralyzed by stroke. The fractures are usually caused by accidental falls. One study shows that 73 percent of 108 patients studied had fallen in the six months after suffering a stroke. Research has shown that stroke patients fall to the side of the paralysis and are less able to stretch out an arm on that side to cushion the fall. Lower limb dysfunction and visual impairment also make them more likely to fall.

Stroke patients who break their hips also have a higher mortality and
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
2-May-2002


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