The relationship between falls and hip bone mineral density of paretic and nonparetic limbs after stroke.

Abstract

Background: Poststroke osteoporosis, particularly of the hip, and an increased risk of fractures due to accidental falls are well known in people with stroke. Only a few of the current stroke guidelines recommend bone mineral density (BMD) measurements during follow-up in this population and measurements are often performed unilaterally.

Objectives: To compare femoral hip BMD between fallers and nonfallers among patients with stroke, while also assessing differences in balance, mobility, fear of falling, and exploring discrepancies between paretic and nonparetic sides within each group.

Design: Cross-sectional.

Setting: Inpatient stroke rehabilitation unit of a tertiary university hospital.

Patients: Patients with unilateral hemiplegia hospitalized as a result of stroke.

Interventions: Not applicable.

Main outcome measures: The primary outcome was the femoral neck BMD measurement. Dual-energy x-ray absorptiometry was used to measure BMD. Secondary outcomes included Berg balance scale (BBS), timed up-and-go test (TUGT), functional ambulation classification (FAC), and falls efficacy scale-international (FES-I).

Results: A total of 44 patients were enrolled. Twenty-two participants (50%) reported falling. There were no statistically significant differences in BMD (p = .504, p = .197, p = .667, respectively) and T-scores (p = .457, p = .194, p = .693, respectively) of paretic, nonparetic femoral neck, and lumbar spine between nonfallers and fallers. The BBS (p = .033, 95% confidence interval [CI] 0.17-19.05) was significantly lower in the fallers. The FES-I was statistically significantly higher in the fallers (p = .001, 95% CI -22.40 to -6.50). The BMD and T-scores of femoral neck between the paretic and the nonparetic limbs did not differ significantly in the nonfallers (n = 22) (p = .908, 95% CI -0.03-0.03; p = .886, 95% CI -0.27-0.24) but did differ in the fallers (n = 22) (p = .007, 95% CI -0.06 to -0.01; p = .006, 95% CI -0.51 to -0.09).

Conclusions: This study emphasizes that hip BMD may differ on paretic and nonparetic sides, especially in patients with stroke and a history of falls and balance problems. Fall-related self-efficacy and balance may be determinants of falls in these patients.