Stroke. 2001 Jul;32(7):1673-7.
Sato Y, Asoh T, Kondo I, Satoh K.
Department of Neurology, Kurume University Medical Center, Japan. noukenrs at cc.hirosaki-u.ac.jp
BACKGROUND AND PURPOSE: Risk of hip fracture after stroke is 2 to 4 times that in a reference population. Osteomalacia is present in some patients with hip fractures in the absence of stroke, while disabled elderly stroke patients occasionally have severe deficiency in serum concentrations of 25-hydroxyvitamin D (25-OHD) (</=5 ng/mL). To determine the effects of vitamin D status on hip fracture risk, we prospectively studied a cohort of patients with hemiplegia after stroke who were aged at least 65 years.
We compared baseline serum indices of bone metabolism, bone mineral density, and hip fracture occurrence in stroke patients with serum 25-OHD </=25 nmol/L (</=10 ng/mL; deficient group, n=88) with findings in patients from the same cohort who had 25-OHD levels 26 to 50 nmol/L (10 to 20 ng/mL; insufficient group, n=76) or >/=51 nmol/L (>/=21 ng/mL; sufficient group, n=72).
RESULTS: Over a 2-year follow-up interval, hip fractures on the paretic side occurred in 7 patients in the deficient group and 1 patient in the insufficient group (P<0.05; hazard ratio=6.5), while no hip fractures occurred in the sufficient group. The 7 hip fracture patients in the deficient group had an osteomalacic 25-OHD level of <5 ng/mL. Higher age and severe immobilization were noted in the deficient group. Serum 25-OHD levels correlated positively with age, Barthel Index, and serum parathyroid hormone.
CONCLUSIONS: Elderly disabled stroke patients with serum 25-OHD concentrations </=12 nmol/L (</=5 ng/mL) have an increased risk of hip fracture. Immobilization and advanced age cause severe 25-OHD deficiency and consequent reduction of BMD.
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Top Stroke Rehabil. 2007 Jul-Aug;14(4):67-79.
Preventing hip fracture after stroke.
Bast BA, Greenwald BD.
Department of Orthopaedics, Sports and Spine Rehabilitation, Beth Israel Medical Center, New York, USA.
Hip fracture after stroke is a frequently occurring and costly complication. The bone quality of stroke survivors is affected by decreased mobility, asymmetric weight bearing, and impaired vitamin D stores. Simultaneously, the risk of falling after stroke is often increased by various impairments. Yet, attempts to limit falls are not enough to prevent fractures. Closer attention to bone health is also needed. Bone markers, which reflect the dynamics of bone remodeling, are becoming more available. Activity is necessary for bone health, but there are no clear guidelines for the type and amount of therapeutic exercise. New metrics for studying bone mineral density and exercise are on the horizon. Finally, there appears to be a role for bisphosphonate prophylaxis in a yet-to-be-defined at-risk population of stroke survivors. The purpose of this review is to discuss the setting for hip fracture after stroke and assess emerging treatments and technologies that may be used to combat the problem.
- Overview Stroke and vitamin D
- Overview Fractures and Falls and Vitamin D
- More muscle response when have adequate vitamin D
Those with low vitamin D less likely to have enough muscle strength/speed to stop a fall.
- Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013
- 5X fewer hip fractures from Parkinson – Alzheimer – Stroke with enough sun – June 2011
- Total hip replacement: 14 times more likely to redo if low vitamin D – March 2017
Diseases that may be related via low vitamin D contains the following list+Some of the disease associations: Disease 1 ==> Disease 2 (both associated with low vitamin D
- Statins ==> many diseases associated with low vitamin D update Jan 2012
- Parkinson, Alzheimer, Stroke ==>Hip fracture
- Parkinson's ==> Osteoporosis
- Low Grip Strength ==> Osteoporosis
- Immune System disease (CVID) ==> Osteoporosis
- COPD ==> Osteoporosis
- COPD ==> Bone Fracture 4.7 X
- COPD ==> osteoporosis, cardio., skeletal muscle, anemia, metabolic synd.
- HIV ==> Osteoporosis
- Prostate Cancer ==> Osteoporosis
- Atopic Dermatitis ==> Osteopenia 1.8 X
- Alopecia Areata spot baldness ==> 5X higher risk of Lupus, vitiligo, metabolic syndrome
- Prostate Cancer ==> Melanoma
- Skin wrinkles ==> Fragile bones
- Depression ==> Fragile bones
- Depressed ==> Stroke 1.7X
- Depression ==> Heart Disease 1.4X
- Depression + Stroke ==> death 3X
- Depression ==> premature birth
96% increase in premature birth if anti-depressants in late pregnancy
- Depression ==> Cognitive Decline
- Acne ==> Depression
- Depression <==> Diabetes
- Diabetes ==> Cognitive impairment
- Diabetes ==> Vertebral fracture in men only
- Diabetes ==> Rheumatoid Arthritis
- Diabetes ==> PCOS women
- PCOS ==> Diabetes
- Asthma ==> Diabetes 10X
- ear, nose, and throat infection ==> Diabetes 10X
- Periodontitis + Low Vit D ==> Diabetes 2.8X
- Obesity ==> Diabetes
- Diabetes ==> Pancreatic Cancer
- Diabetes ==> Cancers
- Diabetes ==> Alzheimer's
- Diabetes ==> TB?
- Diabetes (T1) ==> Multiple Sclerosis
- Diabetes ==> Parkinson's
- Smoking ==> weak bones
- Dental problems==> depression (pregnancy)
- Endometriosis ==> Coronary Heart Disease 3X
- Pregnancy ==> dental problems
- Pregnancy ==>Restless Legs
- No molar ==> 12X increase in Breast Cancer
- Obesity <==> Multiple Sclerosis
- Obesity ==> Cognitive Decline
- Obesity ==> Psorasis
- Obesity ==> Cancer
- Obesity ==> Migraine Headache 3X
- Aortic calcification==> Vertebral fracture
- Low vitamin D for various reasons ==> 9X Suicide
- Asthma ==> Heart Problems and death
- Kidney ==> Tooth loss 7X
- Kidney Disease ==> Osteoporosis 2014 full text
- Multiple Sclerosis ==> Asthma 3X
- Multiple Sclerosis ==> 2.6X increased Migrane Headache, web, full text online
- Multiple Sclerosis ==> Fractures 4X
- Multiple Sclerosis ==>>Fibromyalgia
- Multiple Sclerosis ==> Diabetes (T1)
- Psoriasis ==> Metabolic Syndrome on the web
- Psoriasis ==> Metabolic Syndrome
- Psoriasis ==> Kidney Disease
- Psoriasis ==> Heart problems
- Psoriasis ==> Diabetes
- Psoriasis==> Osteoporosis
- Psoriasis ==> Sleep Apnea
- Celiac Disease ==> Anemia, Psoriasis
- Celiac Disease ==> poor bones Aug 2014
- Intestinal Failure (gut) ==> Low Bone Mineral Density
- Chronic Pancreatitis ==>Painful bones
- Rheumatoid Arthritis ==> Cardiovascular
- Rheumatoid Arthritis ==>Psorasis 3.6X
- IBD ==> Cancer
- Stroke ==> Hip Fracture
- Stroke ==> Parkinson's Disease 2.4X
- Restless Legs <==> ADHD
- Schizophrenia ==> Depression
- Schizophrenia ==> Diabetes 3X
- Sleep Apnea ==>Fatty Liver disease
- Sleep Apnea ==>Gout
- Gout ==> Depression 3.8 X
- Hepatitis-C ==> Cancers - liver, prostate, ?
- Hepatitis -C ==> peripheral arterial disease 12X increase if > 65 years old
- Vitiligo ==> thyroid problems 2013
- Rickets ==> Autism
- Autism ==> Poor Bones
- Epilepsy ==> Osteoporosis
- Rickets ==> Breathing