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 .
The relationship between bone mineral density and immobilization duration in hemiplegic limbs
Objective Prolonged immobilization in stroke is known to result in hypercalciuria , hypercalcemia , accelerated bone resorption , and osteoporosis . Furthermore , bone mineral loss accelerated with increasing duration of hemiplegia . Although stroke is a common disease that causes sudden immobilization , relatively few investigations of bone metabolism in stroke have been reported . The aim of this study was to investigate the changes in bone mineral density of the forearms and legs related to duration of hemiplegia-induced immobilization after stroke . Methods Forty-one hemiplegic patients with stroke were evaluated . The patients ’ age , gender and duration of hemiplegia-induced immobilization were recorded . The measurements of bone mineral density ( BMD ) in all patients were evaluated with DEXA using the Norl and apparatus . The BMD values ( g/cm2 ) were determined by measurements made in the lumbar vertebrae , both forearm and legs ( femoral neck and trochanter ) . Results We found that bone mineral density was decreased in the affected extremities relative to the intact contralateral side on measurements by dual energy x-ray absorptiometry in bones such as forearm , femoral neck and trochanter . There was a significant difference between bone mineral density of paretic and nonparetic forearms and legs . Bone mineral density of the upper limbs was lower than that of the lower limbs . There was a negative correlation between duration of hemiplegia and BMD values . Conclusions Bone mineral loss may be related to the duration of hemiplegia-induced immobilization . Bone mineral loss is accelerated when the duration of hemiplegia is prolonged
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 .