title: Predictors of low bone mineral density of the stroke-affected hip among ambulatory individuals with chronic stroke.
abstract: Risk of hip fracture is greater poststroke than in an age-matched healthy population, in part because of declining hip BMD. We found that individuals may be at risk of loss of hip BMD from muscle atrophy, asymmetrical gait, and poor affected-side ankle dorsiflexor strength. These impairments may be targeted during rehabilitation.
  
  
  BACKGROUND
  This study aimed to determine predictors of low hip BMD on the stroke-affected side in people living in the community.
  
  
  METHODS
  Forty-three participants (female; 27.9%), mean age 62.4 ± 13.5 and 17.9 ± 32.8 months, poststroke with motor impairments underwent dual energy X-ray absorptiometry scans. Gait characteristics, isometric strength, body composition, and fasting plasma lipids were measured.
  
  
  RESULTS
  At entry, 34.9% (15/43) of the participants had low total hip BMD on the stroke-affected side. Of those with low BMD, 93.3% (14/15) had a step length symmetry ratio >1, indicating greater reliance on the non-paretic leg for weight bearing. Logistic regression analysis revealed that lower affected-side ankle dorsiflexor strength (ß = 0.700, p = 0.02), lower total body fat-free mass index (ß = 0.437, p = 0.02), and greater step length symmetry ratio during walking (ß = 1.135 × 10(3), p = 0.03) were predictors of low hip BMD.
  
  
  CONCLUSIONS
  Low BMD of the stroke-affected side hip is prevalent in over a third of individuals with lower limb motor impairments. These individuals may be at particular risk of accelerated loss of BMD at the hip from asymmetrical gait pattern and poor affected-side ankle dorsiflexor strength. These impairments are intervention targets that may be addressed during rehabilitation which includes resistance training and addresses gait impairments.
authors.affiliation: University Health Network, Toronto Rehabilitation Institute, Toronto, Canada, Susan.marzolini@uhn.ca.
authors.forename: S
authors.initials: S
authors.lastname: Marzolini
authors.forename: W
authors.initials: W
authors.lastname: McIlroy
authors.forename: A
authors.initials: A
authors.lastname: Tang
authors.forename: D
authors.initials: D
authors.lastname: Corbett
authors.forename: B C
authors.initials: BC
authors.lastname: Craven
authors.forename: P I
authors.initials: PI
authors.lastname: Oh
authors.forename: D
authors.initials: D
authors.lastname: Brooks
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition / Q000502:physiology; D015519:Bone Density / Q000502:physiology*; D002908:Chronic Disease; D005260:Female; D005684:Gait / Q000502:physiology; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation
chemical_list: D008055:Lipids