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 .
A Single Infusion of Zoledronate Prevents Bone Loss After Stroke
Background and Purpose — Stroke is a major risk factor for hip fracture . Patients with intermediate rather than severe or mild stroke deficits at the time of hospital discharge have the most fractures . This proof-of-concept study evaluated the efficacy of a single infusion of zoledronate , an intravenous bisphosphonate , in preserving hip bone density after stroke . Methods — In a 1-year r and omized , double-blind , placebo-controlled , clinical trial , 27 newly hemiplegic patients ( 6 females , 21 males ) with acute stroke were assigned to receive 4 mg of the intravenous zoledronate ( n=14 ) or placebo ( n=13 ) within 35 days . Strict inclusion criteria were followed-up to ensure recruited patients were likely to have residual functional impairment . Both groups received calcium and vitamin D supplementation . The primary outcome measure was the change in bone mineral density ( BMD ; Lunar Prodigy ) at the hemiplegic hip during the year of investigation . Results — The treatment was generally well tolerated . Mean total hip BMD was unchanged in the hemiplegic hip of the zoledronate group ( mean 0.0 % change ) , whereas in the placebo group the total hip BMD changed by −5.5 % , with the greatest bone loss observed in the trochanteric subregion ( mean , −8.1 % ) . On the unaffected side the mean change in total hip BMD was + 1.0 % with zoledronate versus a mean change of −2.7 % without . Repeated measures ANOVA confirmed the significance of the differences between groups at both hips ( hemiplegic , P<0.001 ; unaffected , P=0.002 ) . Conclusions — Stroke patients were protected from the deleterious effects of hemiplegia on hip bone density for at least 1 year after a single infusion of zoledronate
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 .