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Stroking Bone Health

Report suggests doctors overlook common complication of stroke -- osteoporosis

THURSDAY, May 2, 2002 (HealthDayNews) -- If you're like most folks, the word "stroke" usually brings to mind problems such as speech difficulty, memory loss or even paralysis.

Now, a new medical report from the University of Cambridge in England says that when we think of stroke we should also think of osteoporosis -- the potentially devastating bone-thinning disorder.

Although many associate osteoporosis exclusively with menopause, it's also a complication of stroke in both men and women, says a new report in tomorrow's American Heart Association journal, Stroke.

For New York City endocrinologist and bone health guru Dr. David A. Zackson, the report speaks the truth.

"Most people are not aware that osteoporosis can set in after a stroke and that it can do so rather quickly, in some instances making stroke recovery far more difficult," says Zackson, an associate professor of medicine at New York Weill Cornell Medical Center.

According to the new report, the series of physical changes that often follow a stroke can easily disturb a natural bone-making process known as resorption. Throughout our adult life, our bone cells continually die and are replaced by new cells -- a system that helps keep our skeleton healthy and strong. One of the things that aids the process is the simple act of moving, particularly weight-bearing movements such as walking.

As the researchers point out, however, the sudden lack of mobility that often follows a stroke, combined with loss of limb function -- usually on one side of the body -- can tip the scale on bone production. This causes cells to be lost much faster than they are gained, particularly in certain areas such as the hip bone.

This, combined with a decrease in sensory perceptions such as balance, which often follows stroke, can dramatically increase the risk of hip fractures in these patients, the researchers say.

Perhaps even more important than recognizing the effects of bone loss is heeding the need for treatment. According to the new report, many doctors still do not incorporate therapy for bone loss into the post-stroke care regime.

Zackson agrees: "I do think the problem of osteoporosis in stroke patients is under treated. And I also believe one of the most effective treatment options is being overlooked."

That treatment involves intravenous administration of the commonly used class of osteoporosis drugs known as bisphosphonates -- a medication you may know in tablet form as either Fosamax or Actonel.

"The intravenous treatment can be done in just a few hours in the doctor's office, and it provides protection from bone loss for up to six months," Zackson says.

Moreover, the payoff with intravenous treatment is virtually immediate. With the tablet form of bisphosphonates, "even under optimal circumstances [it] takes at least six months to get optimal results -- in some people a year," Zackson says.

"You can stop bone loss within 72 hours after [intravenous] treatment, and nothing else works this fast or this effectively," Zackson says.

This is exactly what the new report discovered.

After reviewing all current methods of fracture prevention -- including not only drug treatments, but also mechanical hip protectors -- the researchers say intravenous bisphosphonate treatment may be the best option for the prevention of early post-stroke bone loss.

However, there's virtually no data on which stroke patients would benefit most from intravenous treatment. So, the new report calls for a placebo-controlled, randomized trial, a study in which half the patients would receive the bisphosphonate treatment following a stroke and half would receive a placebo.

Zackson agrees such a study is essential.

"I believe it would show just how dramatic of an improvement there can be, and how reducing the risk of broken bones can aid in the overall recovery from stroke," he says.

There's one caveat: Currently, the use of intravenous bisphosphonates for the treatment of osteoporosis is considered experimental. That means the cost is not covered under Medicare and not reimbursable by most insurance companies. At around $550 a treatment, it can be costly.

While experts say taking both vitamin D and calcium following a stroke can offer some protection by giving the body what it needs to build new bone, Zackson says that unless steps are taken to stop bone loss, the nutrients won't be that effective.

Other medications used in the treatment of osteoporosis, including estrogen and the newer designer estrogen drugs, are not recommended for use following stroke because of potential clotting problems.

What To Do: To learn more about drug treatments for osteoporosis, visit The National Osteoporosis Foundation. For more information on stroke rehabilitation, check with the American Heart Association.

SOURCES: David A. Zackson, M.D., endocrinologist and associate professor, medicine, New York Weill Cornell Medical Center, New York City; May 2002 Stroke
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