Influence of immobilization on bone mass and bone metabolism in hemiplegic elderly patients with a long-standing stroke
Authors: K Oizumic
Y Sato
Y Fujimatsu
M Kaji
M Kikuyama
Journal: Journal of the neurological sciences (1998)
Discipline: NEUROSCIENCE & BEHAVIOR
Keywords: bone mass reduction; stroke patients; hemiplegic side; vitamin D deficiency; immobilization

Abstract:  Significant bone mass reduction occurs in stroke patients on the hemiplegic side compared with the intact side, correlating with the degree of paralysis and vitamin D deficiency. To evaluate the influence of long-standing immobilization on this osteopenia, we measured various serum markers of bone metabolism in 93 hemiplegic elderly patients with a long-standing stroke and in 37 controls. The bone mineral density (BMD) of the second metacarpal was determined bilaterally. The scoring of the stroke patients activity was based on the Barthel Index (BI). The serum ionized calcium was higher in the patients than in the controls, correlating negatively with the BI in the patients. The concentrations of parathyroid hormone (PTH), pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen and bone Gla protein were normal or low. The serum 25-hydroxyvitamin D level was low in the patients, correlating positively with the BMD on both sides. The serum 1,25-dihydroxyvitamin D (1,25-[OH]2D) level was markedly reduced in the patients. Hemiplegia from a stroke can result in immobilization hypercalcemia which inhibits PTH secretion and 1,25-[OH]2D production. Bone remodelling may have almost reached an equilibrium, resulting in a steady rate of bone loss. This and the hypovitaminosis D appear to be the dominant causes of immobilization-induced osteopenia in elderly, long-standing hemiplegic stroke patients. 

Retracted: No

PubPeer comments:
 This paper should be retracted. There is a context of multiple ( 90) retractions of work by this group of researchers for a wide range of reasons that include fabrication, authorship misconduct, duplicate data reporting, plagiarism, unethical research practices, unresolved concerns about data integrity and scientific misconduct (http: retractionwatch.com the-retraction-watch-leaderboard ). The journal and its publisher were notified about the concerns with this paper in October 2018 Concerns Ethical oversight The study was reported to be approved by the Futase institutional ethics committee. However, recent retractions of papers by Dr Sato and colleagues by Stroke and Bone indicate that Futase Hospital did not have an ethics committee at the time the work reported in J Neurol Sci was supposedly conducted. Thus, this work is unethical. Funding No funding support is reported for a moderately large cross-sectional study. Implausible participant recruitment 122 patients with hemiplegic stroke of 1 month duration and without several co-morbid conditions were evaluated at a 55 bed, 4 physician hospital in only 3 months (June-August 1996), a highly implausible rate of 40 month. The stated recruitment rate is rendered even more implausible when one considers that during the same 3 month period, at the same small institution, Dr Sato and colleagues allegedly evaluated: 71 patients with Parkinsonu2019s disease (Neurology 1997;49:1273-1278) 321 patients 65y chronically hospitalized stroke patients without several co-morbid conditions (Age Ageing 1999;28:265-9) And were recruiting (April 1996-March 1997) 168 patients 65y with hemiplegic stroke of 2y duration (Am J Phys Med Rehabil 1999;78:317-22) And were undertaking a clinical trial of steroids for neuroleptic malignant syndrome in Parkinsons Disease (J Neurol Neurosurg Psych 2003;74:574-6) Implausible biochemical testing Several biochemical tests reported to have been undertaken, eg 25 (OH)D, 1,25(OH)2D, ionized calcium, PTH, ICTP, and osteocalcin, are not standard and require specialised laboratory facilities that are extremely unlikely to be available at a hospital the size of Futase Hospital. No analytic laboratory is identified in the paper, and no funding is reported that would support this costly exercise. Overlapping and duplicate implausible data with other publications Please refer to the table, which sets out data from the control groups of several publications by Dr Sato and colleagues. The current paper is in the top row. It is readily apparent that mean and or SD values for several variables in the control group in this J Neurol Sci paper are identical with those in the control groups in other papers, despite the groups differing in size, age and gender composition. Mean and SD data for ionized calcium in the control group in this paper are identical to those in the control groups in 7 other papers. Mean and SD data for 1,25(OH)2D in this paper are identical to those in 5 other papers. These data are very very unlikely to be reliable. ![file] Impossible data The mean value for a variable in the whole group should = the sum of the mean value x n of each subgroup, divided by the total n. In Table 1, the mean value for BMD hemiplegic side in the whole cohort, 2.022, does not equal the value calculated from the male and female subgroups: 54 x 2.024 + 39 x 1.644, divided by 93 = 1.865. These data are mathematically impossible. In Table 1, the mean value for BMD intact side in the whole cohort, 2.300, does not equal the value calculated from the male and female subgroups: 54 x 2.613 + 39 x 1.921, divided by 93 = 2.323. These data are mathematically impossible. , 
 It is now 21 months since Elsevier communicated, via COPE, its undertaking to retract this paper. Recent requests for an update on the retraction to Elsevier, COPE, and the journal did not receive a response. The society associated with the journal, the World Federation of Neurology, responded but was unable to provide any information. , 
 #2 I applaud your effort to correct the scientific record! I would also like to point out that action on this is still very much relevant. As recently as 2020, [Lee et al.] have cited this, and one other paper by Sato. ,