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 .
Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: bone adaptation after decreased mechanical loading.
The aim of this 1-year prospect i ve study of acute stroke patients was to determine the effects of walking and asymmetrical weight bearing on the loss of bone mineral in the upper and lower femoral neck . Forty patients were followed . Eight remained unable to walk , whereas 32  relearned to walk independently within 7 months ( 12 shortly after the stroke , 15 by 2 months , 5 by 7 months ) . Bone mineral density ( BMD ) was measured in the proximal femur within the first week after stroke and 1 year later ; regional BMD changes were computed for the lower and upper femoral neck . The lower part of the femoral neck is mainly influenced by compressive stresses of the hip , the upper part by tensile stresses during walking . When comparing mean BMD loss in groups of patients according to when they relearned to walk , a statistically significant trend in BMD loss was found in the lower femoral neck on both the paretic and nonparetic sides ( p < 0.01 and p = 0.01 , respectively ) , whereas , for the upper femoral neck , no significant trend was seen ( p > /= 0.1 ) . In addition , the body weight distribution during st and ing was assessed by use of a force-plate in 38 patients who could st and independently at the 7 month evaluation . The only significant correlation between changes in BMD and asymmetrical weight bearing was found in the lower femoral neck on the paretic side ( r = 0.6 , p < 0.001 ) . In conclusion , this study shows that the reduction in BMD in the femoral neck occurs mainly in the lower part of the neck and on the paretic side . The BMD loss depended on when or if the patients relearned to walk , but also on the amount of body weight born on the paretic leg . Thus , measuring the lower part of the femoral neck gives a better estimate of the impact of gait and weight bearing than measuring the total femoral neck
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 .