In subacute and chronic stroke studies , the skeletal sites in the paretic limbs sustained a more pronounced decline in bone quality than did their counterparts in the non-paretic limbs .
The rate of changes showed a decelerating trend as post-stroke duration increased , but the timing of achieving the steady rate differed across skeletal sites .
The magnitude of bone changes in the paretic upper limb was more pronounced than the paretic lower limb .
There was a strong relationship between muscle strength/mass and bone density/strength index .
Muscle spasticity seemed to have a negative impact on bone integrity in the paretic upper limb , but its influence on bone properties in the paretic lower limb was uncertain .
Substantial bone changes in the paretic limbs occurred particularly in the first few months after stroke onset .
Early intervention , muscle strength training , and long-term management strategies may be important to enhance bone health post-stroke .
To systematic ally review available evidence related to the characteristics of bone changes  post-stroke and the relationship between various aspects of muscle function ( e.g. , strength , spasticity ) and bone properties after stroke onset .
Adding injury to insult: fracture risk after stroke in veterans.
OBJECTIVES To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts . DESIGN Secondary analyses of two prospect i ve cohorts . SETTING Veterans Affairs ( VA ) Medical Centers . PARTICIPANTS The VA Acute Stroke ( VASt ) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997 . The Integrated Stroke Outcomes Data base ( ISOD ) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002 . MEASUREMENTS Fractures detected using International Classification of Diseases , 9th Revision , codes in the VA computerized patient record system ; baseline patient characteristics and stroke features ; Functional Independence Measures scores in ISOD . RESULTS Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1 % and 4.7 % , respectively . Longer hospitalizations for stroke ( P=.06 ) and new motor or sensory impairment ( P=.09 ) showed trends toward greater risk in the VASt cohort . Female sex ( P < .001 ) , cognitive impairment ( P=.01 ) , and nonblack race ( P=.04 ) were associated with higher fracture risk in the ISOD . Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment . CONCLUSION Veterans who suffer a stroke are at high risk of subsequent fracture , which can lead to further disability . Women , nonblacks , and those with intermediate functional impairment were at particularly high risk of fracture . Future study should investigate therapies to decrease fracture risk in stroke patients
In subacute and chronic stroke studies , the skeletal sites in the paretic limbs sustained a more pronounced decline in bone quality than did their counterparts in the non-paretic limbs .
The rate of changes showed a decelerating trend as post-stroke duration increased , but the timing of achieving the steady rate differed across skeletal sites .
The magnitude of bone changes in the paretic upper limb was more pronounced than the paretic lower limb .
There was a strong relationship between muscle strength/mass and bone density/strength index .
Muscle spasticity seemed to have a negative impact on bone integrity in the paretic upper limb , but its influence on bone properties in the paretic lower limb was uncertain .
Substantial bone changes in the paretic limbs occurred particularly in the first few months after stroke onset .
Early intervention , muscle strength training , and long-term management strategies may be important to enhance bone health post-stroke .
To systematic ally review available evidence related to the characteristics of bone changes  post-stroke and the relationship between various aspects of muscle function ( e.g. , strength , spasticity ) and bone properties after stroke onset .