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Title: Upright activity and higher motor function may preserve bone mineral density within 6 months of stroke : a longitudinal study
Authors: Borschmann, K
Iuliano, S
Ghasem-Zadeh, A
Churilov, L
Pang, MYC 
Bernhardt, J
Issue Date: 2018
Source: Archives of osteoporosis, 2018, v. 13, no. 15
Abstract: 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 prospective 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 standing 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: Unique identifier: ACTRN12612000123842.
Keywords: Bone loss
Bone mineral density
Physical activity
Publisher: Springer
Journal: Archives of osteoporosis 
ISSN: 1862-3522
EISSN: 1862-3514
DOI: 10.1007/s11657-017-0414-4
Rights: © The Author(s) 2018. This article is an open access publication
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:/ /, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
The following publication Borschmann, K., Iuliano, S., Ghasem-Zadeh, A. et al. Upright activity and higher motor function may preserve bone mineral density within 6 months of stroke: a longitudinal study. Arch Osteoporos 13, 5 (2018) is available at
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