Review |
Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence
1 Brook 417, Clinical Practice Research Unit, Department of Nursing, University of Central Lancashire, Preston PR1 2HE, UK
2 University of Edinburgh, College of Medicine and Veterinary Medicine, The Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
3 Consultant Physician in Medicine for the Elderly/Clinical Director, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
4 Consultant Physician in Medicine for the Elderly, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
5 Brook 419, Department of Nursing, University of Central Lancashire, Preston PR1 2HE, UK
Address correspondence to: Jenny Marsden. Tel: 01772 895136; Fax: 01772 894935. Email: JMarsden2{at}uclan.ac.uk
Background: bone loss post-stroke can lead to an increased risk of fracture. Fractures compound the effects of a stroke, resulting in greater dependency for the individual and an increased burden for health and social care.
Objectives: to identify risk factors for bone loss post-stroke and appraise bone loss or fracture risk reduction interventions. To develop a research agenda that informs the design and development of risk reduction strategies.
Design: an integrative review.
Methods: the search strategies used in Medline, Embase, AMED and CINAHL from 1966 to July 2006 identified 530 records. Ninety-nine papers with a focus on risk factors or interventions to prevent bone loss or fractures post-stroke were identified. Hand searching and scoping grey literature produced 59 additional papers. Data analysis, including data reduction and data display using matrices, enabled patterns and themes to be derived from differing study designs.
Results: risk factors for bone loss post-stroke are reduced mobility, vitamin D deficiency, gender and time since stroke. Early mobilisation post-stroke may reduce bone loss, and so avoid fractures, but evidence is needed. Providing vitamin D supplements and Bisphosphonates in post-stroke patients tends to reduce bone loss, but larger treatment trials are required.
Conclusions: the evidence base for bone loss management post-stroke is limited. Large, prospective, multi-centre, longitudinal studies are needed to clarify optimum treatments to reduce post-stroke bone loss, and test the effects on clinical outcomes. A ‘skeletal health’ checklist to aid implementation of treatments within stroke rehabilitation has been suggested but not yet developed.
Keywords: cerebrovascular accident, hemiplegia, fractures, osteoporosis bone density, elderly
Received 22 May 2007; accepted in revised form 27 September 2007.