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Stroke Increases Risk of Osteoporosis

Though stroke and the bone-thinning disease osteoporosis are usually thought of as two distinct health problems, an analysis of several studies finds a strong connection between them. Specifically, researchers have found that patients who survive strokes are significantly more likely to suffer from osteoporosis, a disease that puts them at high risk for bone fractures. The majority of fractures in stroke patients occur on the side of the body that has been paralyzed from the stroke, according to the analysis. Based on these data, the researchers suggest adding osteoporosis treatment to stroke rehabilitation.

A stroke occurs when the supply of blood and oxygen is cut off to part of the brain. If a portion of the brain loses its supply of nutrient-rich blood and oxygen, the bodily functions controlled by that part of the brain (vision, speech, walking, etc.) are impaired. Each year more than 500,000 people in the United States suffer strokes and 150,000 of those people die as a result. Risk factors for stroke include age, family history of stroke, smoking, lack of physical activity, and high blood pressure. While the treatment of stroke usually focuses on improving functions affected by the stroke (such as mobility), most rehabilitation does not include the prevention of bone loss.

To better understand the connection between stroke and osteoporosis, an analysis of several studies was conducted by Kenneth Poole, BM, MRCP and his colleagues from the Department of Stroke Medicine and Medical Research Council Bone Research Group of Addenbrooke’s Hospital in Cambridge. The researchers examined the risk of hip fractures in patients who had suffered strokes.

In a Swedish study, Poole and his team say that stroke patients are two to four times more likely to suffer hip fractures than similarly aged healthy people. Another Swedish study found that patients who suffered strokes quadrupled their risk of hip fractures immediately after the stroke. In a separate analysis, 73% of 108 stroke patients were found to have fallen within six months of suffering a stroke. Falling is a significant risk factor for hip fractures, especially among elderly people. The average age of a stroke victim is 70, according to Poole and his colleagues.

The analysis also found that patients who suffered strokes were more likely to die from hip fractures or experience a reduced quality of life compared to similarly aged healthy people. Since the majority of stroke patients are already have an elevated risk of osteoporosis due to their age, the immobility caused by a stroke can lead to a substantially increased risk of bone fractures among these patients.

Therefore, Poole and his colleagues suggest that stroke patients be treated aggressively to help prevent the potentially devastating effects of osteoporosis. The researchers suggest the use of drugs called bisphosphonates early during stroke rehabilitation. Bisphosphonates such as Fosamax (generic name, alendronate) or Actonel (generic name, risedronate sodium) are non-hormonal therapies that help increase bone mineral density, which can prevent bone fractures. Because the pill forms of these drugs require that patients remain in an upright position for at least 30 minutes after taking them, the researchers say the drugs would most likely have to be administered intravenously (through a vein) in stroke patients.

Other methods of treating osteoporosis include:

  • Changing diet to include more calcium and vitamin D
  • Increasing physical activity
  • Hormone replacement therapy (HRT)
  • Other drug therapies, such as Evista (generic name, raloxifene) or Miacalcin (generic name, calcitonin)

Additional Resources and References