JORR
Journal of Orthopedics Research and Rehabilitation

The Journal of Orthopedics Research and Rehabilitation welcomes scholarly papers in orthopaedic surgery, physical therapy and rehabilitation, physiotherapy, neurology and clinic anesthesiology and reanimation.

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Original Article
Association between bone mineral density and clinical-demographic characteristics in patients with post-stroke hemiplegia
Abstract
Aims: This study aimed to investigate the association between bone mineral density and clinical-demographic characteristics in patients with post-stroke hemiplegia and to evaluate potential factors associated with osteoporosis.
Methods: This retrospective, cross-sectional study included 80 patients with post-stroke hemiplegia who met the inclusion criteria and were followed at Physical Medicine and Rehabilitation Hospital between January 1, 2025, and October 1, 2025. Data were obtained through retrospective review of hospital information system records and patient files. Demographic and clinical characteristics were recorded. Bone mineral density (BMD) values were obtained from dual-energy X-ray absorptiometry (DXA) measurements. Functional status and independence were assessed using the Functional Independence Measure (FIM), while ambulation level was evaluated using the Functional Ambulation Scale (FAS). Serum calcium, parathyroid hormone, and vitamin D levels were also recorded. Associations between variables were analyzed using Spearman’s correlation analysis, and statistical significance was set at p < 0.05.
Results: The mean age of the patients was 65.8±9.5 years, and 56.2% were female. Ischemic stroke was present in 86.2% of patients, and the median stroke duration was 16 (1–288) months. While 16.2% of patients had a prior diagnosis of osteoporosis, this rate increased to 37.5% when newly diagnosed cases were included. No significant difference was found in stroke duration between patients with and without osteoporosis (p = 0.167). No significant differences were observed in FIM, FAS, calcium, parathyroid hormone, and vitamin D levels according to sex, osteoporosis status, comorbidities, or smoking/alcohol use (all p > 0.05). Only parathyroid hormone levels were significantly lower in the hemorrhagic stroke group (p = 0.046), while vitamin D levels tended to be lower in the osteoporosis group (p = 0.059). A statistically significant, moderate, negative correlation was found between age and femoral neck bone mineral density (r = -0.451, p < 0.001).
Conclusion: Osteoporosis is common in patients with post-stroke hemiplegia, and age has a significant negative impact on femoral neck bone mineral density. However, functional status and ambulation level alone are insufficient to explain bone loss. These findings highlight the multifactorial nature of post-stroke osteoporosis and emphasize the clinical importance of early screening and preventive strategies in at-risk patients.

Keywords : Bone density, rehabilitation, vitamin D, risk factors, activities of daily living

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1. Campbell BCV, Khatri P. Stroke. Lancet. 2020;396(10244):129-142. doi:10.1016/S0140-6736(20)31179-X
2. Feigin V, Stark B, Johnson C, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20:795-820. doi:10.1016/S1474-4422(21)00252-0
3. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery. Stroke. 2016;47(6):e98-e169. doi:10.1161/STR.0000000000000098
4. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019; 393(10169):364-376. doi:10.1016/S0140-6736(18)32112-3
5. Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021;16(1):609. doi:10.1186/s13018-021-02772-0
6. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381. doi:10.1007/s00198-014-2794-2
7. Yoo SD, Kim TW, Oh BM, et al. Discordance between spine-hip and paretic-nonparetic hip bone mineral density in hemiplegic stroke patients: a multicenter retrospective study. Ann Rehabil Med. 2024;48(6):413-422. doi:10.5535/arm.240079
8. Osman A, Maya T, Doshi N, et al. Post-stroke bone fragility: early bone loss, risk factors, and recovery considerations. Cureus. 2025;17(8): e89282. doi:10.7759/cureus.89282
9. Lee D, Cho IY, Chang WH, et al. Fracture risk among stroke survivors according to poststroke disability status and stroke type. Stroke. 2024; 55(6):1498-1506. doi:10.1161/STROKEAHA.123.044953
10. Kapral MK, Fang J, Alibhai SM, et al. Risk of fractures after stroke: results from the Ontario Stroke Registry. Neurology. 2017;88(1):57-64. doi:10.1212/WNL.0000000000003457
11. Kanis JA, Glüer CC. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. 2000;11(3):192-202. doi:10.1007/s001980050281
12. Küçükdeveci AA, Yavuzer G, Elhan AH, et al. Adaptation of the functional independence measure for use in Turkey. Clin Rehabil. 2001; 15(3):311-319. doi:10.1191/026921501676877265
13. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients: standards for outcome assessment. Phys Ther. 1986; 66(10):1530-1539. doi:10.1093/ptj/66.10.1530
14. Wang J, Sun Y, Guo X, et al. The effect of stroke on the bone mineral density: a systematic review and meta-analysis. J Nutr Health Aging. 2024;28:100189. doi:10.1016/j.jnha.2024.100189
15. Carda S, Cisari C, Invernizzi M, et al. Osteoporosis after stroke: a review of the causes and potential treatments. Cerebrovasc Dis. 2009;28:191-200. doi:10.1159/000226578
16. Watanabe Y. An assessment of osteoporosis in stroke patients on rehabilitation admission. Int J Rehabil Res. 2004;27:163-166. doi:10. 1097/01.mrr.0000128062.38817.77
17. El-Hewala AEI, Al Sharaki DR, Fotoh DS, et al. Assessment of osteoporosis in hemiplegic patients with stroke. Menoufia Med J. 2019; 32(4):1479-1482. doi:10.4103/mmj.mmj_137_16
18. Liu M, Tsuji T, Higuchi Y, et al. Osteoporosis in hemiplegic stroke patients as studied with dual-energy X-Ray absorptiometry. Arch Phys Med Rehabil. 1999;80:1219-1226. doi:10.1016/S0003-9993(99)90019-9
19. Li J, Shi L, Sun J. The pathogenesis of post-stroke osteoporosis and the role oxidative stress plays in its development. Front Med (Lausanne). 2023;10:1256978. doi:10.3389/fmed.2023.1256978
20. Schnitzer TJ, Harvey RL, Nack SH, et al. Bone mineral density in patients with stroke: relationship with motor impairment and functional mobility. Top Stroke Rehabil. 2012;19(5):436-443. doi:10. 1310/tsr1905-436
21. Yavuzer G, Ataman S, Suldur N, et al. Bone mineral density in patients with stroke. Int J Rehabil Res. 2002;25(3):235-239. doi:10.1097/ 00004356-200209000-00010
22. Lee SB, Cho AH, Butcher KS, et al. Low bone mineral density is associated with poor clinical outcome in acute ischemic stroke. Int J Stroke. 2013;8(2):68-72. doi:10.1111/j.1747-4949.2011.00714.x
Article available in :
Volume 4, Issue 2, 2026
Page : 34-39
https://doi.org/10.51271/JORR-0068
Article Information
Received : 17 Mar 2026
Accepted : 27 Nis 2026
Published : 30 Nis 2026
Corresponding Author :

Zafer Ceyhan: Department of Physical Medicine and Rehabilitation, Samsun Physical Medicine and Rehabilitation Diseases Hospital, Samsun, Turkiye

[email protected]
Citation : Ceyhan Z, Karaçeşme MA. Association between bone mineral density and clinical-demographic characteristics in patients with post-stroke hemiplegia. J Orthop Res Rehabil. 2026;4(2):34-39.

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