Clinical trial NCT04845269: Post-Stroke Osteopathy
Official title: Post-Stroke Osteopathy: Characterization of Fractures and Changes in the Bone Microstructure After Ischemic Stroke or TIA
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Stroke (CVA) or TIA
Fracture
Fall
Keywords: high-resolution peripheral quantitative Computer Tomography
Bone microstructure
Lead sponsor: VASCage GmbH
Sponsor class: OTHER
Collaborators: name: Medical University Innsbruck
First posted: 2021-04-14
Enrollment: 127
Sex: ALL
Minimum age (years): 60
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: As a sub-study of the STROKE-CARD Registry Study the source population will be all patients treated at the Department of Neurology Innsbruck (Austria) for stroke and included in the STROKE-CARD Registry Study. The target study population for the Post-Stroke Osteopathy Study will be all patients included in the STROKE-CARD Registry Study (clinicaltrials.gov ID NCT04582825).

Brief summary: The sudden biomechanical inactivation, direct neuro-humoral effects and sustained systemic stress reaction, which commonly occur after stroke or TIA, all may be of relevance in triggering alterations in bone metabolism and remodelling of bone microstructure.

The objectives of this observational pilot study are to characterize falls and fractures and their circumstances (sex and age specific incidence, time course, risk conditions, localization) in ischemic stroke patients, study changes in the bone microstructure after ischemic stroke supported by high-resolution peripheral quantitative Computer Tomography, unravel a molecular mechanisms underlying the increased fracture risk (focus on Wnt-signaling and ß-adrenergic projection), establish risk factors to estimate the risk of falls based on information from gait analysis as well as construct deep learning algorithms to identify bone microstructure parameters for predicting fractures.


Eligibility criteria: Inclusion Criteria:

* Inclusion in the STROKE-CARD Registry Study
* Modified Rankin Scale (mRS) \< 5
* Provision of signed and dated informed consent form
* Willingness to comply with all study procedures and ability to participate in the study over the complete study duration

Exclusion Criteria:

* Persistent motor deficit before the onset event
* Not able to walk without walking aid or not able to put the full bodyweight on either leg before the onset event
* Medical history of stroke
* Premedication with Corticosteroids for more than 6 Weeks or Pioglitazone or Bisphosphonate within the last 12 months
* Limb amputation
* BMI \< 18,5 kg/m2 or \> 35 kg/m2
* Present or previous fracture in the distal Radius or Tibia interfering with HR-pQCT
* Movement disorder interfering with HR-pQCT imaging
* Women of childbearing potential

Primary outcomes:
measure: Number of patients with and without fractures
timeFrame: 12 months
Secondary outcomes:
Other outcomes:
measure: Changes in imaging bone structure between the baseline and follow-up in all extremities as measured by quantitative CT imaging
timeFrame: 12 months
measure: Number and circumstances (housing situation, concomitant medication, level of immobility,...) of falls between baseline and one-year follow-up
timeFrame: 12 months
measure: Change in blood bone biomarkers (as mentioned before) between baseline and follow-up
timeFrame: 12 months
measure: Circumstances (housing situation, concomitant medication, level of immobility,...) of fractures during the twelve-month follow up
timeFrame: 12 months
Locations:
city: Innsbruck
country: Austria
facility: Medical University of Innsbruck, Department of Neurology
Study officials:
affiliation: Medical University of Innsbruck, Department of Neurology
name: Michael Knoflach, Assoz.Prof. Priv.-Doz. Dr.
role: PRINCIPAL_INVESTIGATOR
References:
citation: GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1736-1788. doi: 10.1016/S0140-6736(18)32203-7. Epub 2018 Nov 8.
citation: Yuan ZC, Mo H, Guan J, He JL, Wu ZJ. Risk of hip fracture following stroke, a meta-analysis of 13 cohort studies. Osteoporos Int. 2016 Sep;27(9):2673-2679. doi: 10.1007/s00198-016-3603-x. Epub 2016 Apr 22.
citation: Ramnemark A, Nyberg L, Borssen B, Olsson T, Gustafson Y. Fractures after stroke. Osteoporos Int. 1998;8(1):92-5. doi: 10.1007/s001980050053.
citation: Ramnemark A, Nilsson M, Borssen B, Gustafson Y. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke. 2000 Jul;31(7):1572-7. doi: 10.1161/01.str.31.7.1572.
citation: Ramnemark A, Nyberg L, Lorentzon R, Olsson T, Gustafson Y. Hemiosteoporosis after severe stroke, independent of changes in body composition and weight. Stroke. 1999 Apr;30(4):755-60. doi: 10.1161/01.str.30.4.755.
citation: Carda S, Cisari C, Invernizzi M, Bevilacqua M. Osteoporosis after stroke: a review of the causes and potential treatments. Cerebrovasc Dis. 2009;28(2):191-200. doi: 10.1159/000226578. Epub 2009 Jun 30.
citation: Poole KE, Vedi S, Debiram I, Rose C, Power J, Loveridge N, Warburton EA, Reeve J, Compston J. Bone structure and remodelling in stroke patients: early effects of zoledronate. Bone. 2009 Apr;44(4):629-33. doi: 10.1016/j.bone.2008.11.017. Epub 2008 Dec 11.
citation: Ramnemark A, Nyberg L, Lorentzon R, Englund U, Gustafson Y. Progressive hemiosteoporosis on the paretic side and increased bone mineral density in the nonparetic arm the first year after severe stroke. Osteoporos Int. 1999;9(3):269-75. doi: 10.1007/s001980050147.