Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Feb 20, 2016; 6(1): 1-8
Published online Feb 20, 2016. doi: 10.5493/wjem.v6.i1.1
Impact and risk factors of post-stroke bone fracture
Kang Huo, Syed I Hashim, Kimberley L Y Yong, Hua Su, Qiu-Min Qu
Kang Huo, Syed I Hashim, Kimberley L Y Yong, Qiu-Min Qu, Department of Neurology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Hua Su, Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94117, United States
Author contributions: Huo K, Hashim SI and Yong KLY analyzed the data and wrote the paper; Qu QM did critical editing; Su H designed the outline of the review and did critical editing; Hashim SI and Yong KLY contributed equally to this work.
Supported by National Institutes of Health, Nos. R01 NS027713, R01 HL122774 and R21 NS083788; the Michael Ryan Zodda Foundation and UCSF Research Evaluation and Allocation Committee (REAC).
Conflict-of-interest statement: The authors have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qiu-Min Qu, MD, PhD, Department of Neurology, the First Affiliated Hospital of Xi’an Jiaotong University, Yanta West road No. 277, Xi’an 710061, Shaanxi Province, China. quqiumin@medmail.com.cn
Telephone: +86-29-85324083 Fax: +86-29-85324083
Received: September 23, 2015
Peer-review started: October 3, 2015
First decision: October 27, 2015
Revised: January 6, 2016
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: February 20, 2016
Abstract

Bone fracture occurs in stroke patients at different times during the recovery phase, prolonging recovery time and increasing medical costs. In this review, we discuss the potential risk factors for post-stroke bone fracture and preventive methods. Most post-stroke bone fractures occur in the lower extremities, indicating fragile bones are a risk factor. Motor changes, including posture, mobility, and balance post-stroke contribute to bone loss and thus increase risk of bone fracture. Bone mineral density is a useful indicator for bone resorption, useful to identify patients at risk of post-stroke bone fracture. Calcium supplementation was previously regarded as a useful treatment during physical rehabilitation. However, recent data suggests calcium supplementation has a negative impact on atherosclerotic conditions. Vitamin D intake may prevent osteoporosis and fractures in patients with stroke. Although drugs such as teriparatide show some benefits in preventing osteoporosis, additional clinical trials are needed to determine the most effective conditions for post-stroke applications.

Keywords: Bone fracture, Recovery, Bone mineral density, Stroke, Osteoporosis

Core tip: Post-stroke bone fracture negatively impacts stroke recovery, prolongs hospital stays, and increases economic cost. Stroke, osteoporosis and bone fracture share common risk factors. The main risk factors for post-stroke bone fracture include aging, osteoporosis, and loss of posture control. Bone mineral density measurement may identify patients who are at risk of post-stroke bone fracture. Drugs and supplements, such as vitamin D and teriparatide, can be tested in clinical settings for prevention of post-stroke bone fracture. Although bisphosphonate’s incur side effects, they are considered first-line drugs to prevent post-stroke bone fracture.