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 .
Progressive Hemiosteoporosis on the Paretic Side and Increased Bone Mineral Density in the Nonparetic Arm the First Year after Severe Stroke

Abstract : Fractures are a common and serious complication after stroke and the risk of hip fractures among stroke patients is 2 to 4 times greater than among other elderly people . The aim of this study was to investigate prospect ively the change in bone mineral density ( BMD ) after severe stroke and to study the association between motor impairment , disability and the development of hemiosteoporosis . The study comprised 24 stroke patients , with no persistent paresis from previous strokes or previous osteoporotic fractures , included 1 month after stroke onset .  BMD , motor function , ambulation and activities of daily living ( ADL )  were assessed at 1 , 4 , 7 and 12 months after stroke onset . At inclusion , the patients ’ BMD was normal for their age . During the study , there was a significant loss of BMD in the total body ( −2.0 % ; p<0.05 ) , but not in the head or spine . BMD differed significantly between the paretic and the non-paretic arm at inclusion ( −4.8 % ; p<0.001 ) . Decrease in BMD was most pronounced in the affected humerus ( −17.4 % ; p<0.001 ) and proximal femur ( −12.2 % ; p<0.01 ) . BMD decreased significantly in both lower extremities during follow-up , but the losses were more pronounced on the paretic side ( p<0.01 ) . In the nonaffected ultradistal radius there was a significant increase in BMD from inclusion to the end of the study ( + 5.8 % ; p<0.01 ) . There was no pattern in the bone losses correlating with presumptive risk factors for hemiosteoporosis such as motor function , ability to perform ADL or ambulation . Two patients had fractures at follow-up , both on the paretic side . Loss of bone mineral density in the paretic extremities is thus pronounced and progressive during the first year after stroke , indicating that loss of BMD is probably an important risk factor for post-stroke fractures . Surprisingly , BMD in the nonaffected arm increased significantly during the first year after stroke , most likely due to increased physical activity , and perhaps a redistribution of bone minerals from the paretic extremities
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 .