Motor Recovery and the Fracture Risk in Patients during Post-Stroke Rehabilitation

Abstract

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Indices of motor recovery and the fracture risk were estimated in patients examined after stroke and suffering from osteoporosis or osteopenia. Our study included 57 patients (29 with osteoporosis and 28 with osteopenia) who received treatment at a rehabilitation clinic. The average age of patients was 69.62 ± 9.86 years. The data were based on anamneses, questionnaires, and bone mineral density (BMD) measured by the DXA method. The fracture risk was assessed by applying the FRAX index. The functional status was evaluated by the Barthel index (BI), and motor recovery was evaluated by the Signe Brunnström scale (SB). The prevalent impairment was left-sided hemiparesis (n = 30; 52.63%). Most patients with stroke and a reduced BMD (42, 73.68%) had low and intermediate risk estimates, while 15 (26.31%) patients had a high risk of major osteoporotic fractures. Patients with stroke and osteopenia had a significantly higher risk for major osteoporotic fractures, compared to patients with osteoporosis (P < 0.001). Concerning the hip fracture, more patients with a reduced BMD (34, 59.65%) had a lower fracture risk than those with an intermediate (15, 26.31%) or high risk (8, 14.03%). The majority of patients had significantly higher scores on the SB scale in lower segments of the extremities. No statistically significant difference in motor recovery between left- and right-sided patients with stroke and reduced BMD was found (P ˃ 0.01). Thus, an association between the high risk level for major osteoporotic fractures and osteopenia was found. Patients with right-sided hemiparesis and osteopenia had more significant reduction in the BMD on the femur, when compared to patients with left-sided hemiparesis. Patients with stroke and an increased fracture risk require preventive individual therapeutic programs in order to avoid fractures.