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 .
Upright activity and higher motor function may preserve bone mineral density within 6 months of stroke: a longitudinal study
Purpose Bone fragility contributes to increased fracture risk , but little is known about the emergence of post-stroke bone loss . We investigated skeletal changes and relationships with physical activity , stroke severity , motor control and lean mass within 6 months of stroke . Methods This is a prospect i ve observational study . Participants were non-diabetic but unable to walk within 2 weeks of first stroke .  Distal tibial volumetric bone mineral density ( vBMD , primary outcome ) , bone geometry and microstructure ( high-resolution peripheral quantitative computed tomography ) were assessed at baseline and 6 months , as were secondary outcomes total body bone mineral content and lean mass ( dual energy X-ray absorptiometry ) , bone metabolism ( serum osteocalcin , N-terminal propeptide of type 1 procollagen ( P1NP ) , C-terminal telopeptide of type 1 collagen ( CTX ) ) , physical activity ( PAL2 accelerometer ) and motor control ( Chedoke McMaster )  which were also measured at 1 and 3 months . Results Thirty-seven participants ( 69.7 years ( SD 11.6 ) , 37.8 % females , NIHSS 12.6 ( SD 4.7 ) ) were included . The magnitude of difference in vBMD between paretic and non-paretic legs increased within 6 months , with a greater reduction observed in paretic legs ( mean difference = 1.5 % ( 95 % CI 0.5 , 2.6 ) , p = 0.007 ) . At 6 months , better motor control was associated with less bone loss since stroke ( r = 0.46 , p = 0.02 ) . A trend towards less bone loss was observed in people who regained independent walking compared to those who did not ( p = 0.053 ) . Higher baseline daily count of st and ing up was associated with less change in bone turnover over 6 months : osteocalcin ( r = −0.51 , p = 0.01 ) , P1NP ( r = −0.47 , p = 0.01 ) , CTX ( r = −0.53 , p = 0.01 ) . Conclusion Better motor control and walking recovery were associated with reduced bone loss . Interventions targeting these impairments from early post-stroke are warranted . Clinical trial registration URL : http://www.anzctr.org.au . Unique identifier : ACTRN12612000123842
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 .