Relationship between bone disorders and stroke
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REVIEW ARTICLE
Relationship between bone disorders and stroke Milija D. Mijajlovic 1
&
Vuk Aleksic 2 & Natasa Stojanovski 3 & Natan M. Bornstein 4,5
Received: 23 May 2020 / Accepted: 19 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Bone disorders are among the most uncommon causes of stroke, but they should be considered as stroke cause in particular clinical scenarios. On the other hand, osteoporosis/osteopenia and increased fracture risk are well documented post stroke complications. The relationship between stroke and bone health is complex. The current facts suggest that these two conditions share same risk factors, but also are risk factors for each other. However, the evidence shows more clear effect of stroke on the bone health, than in the opposite direction. This extensive review is aiming to fill the huge gap of evidence about this topic, and since bone pathology is extremely rare cause of cerebrovascular accident, although a complex connection between these two conditions definitely exists. Keywords Stroke . Risk factors . Bone Pathology . Bone disorders
Body bone pathology There are possible links between bone mineral density (BMD) and stroke, because both conditions may be related to estrogen deficiency, diabetes, hypertension, low level of physical activity, and smoking. A more difficult question is whether there is a cause relationship between low BMD and high risk of stroke, or low BMD is, rather, a marker of poor general health and aging. Two most common methods for assessing BMD are dualenergy X-ray absorptiometry (DXA) and quantitative ultrasound at the peripheral sites, most commonly at the heel (calcaneus bone) [1, 2]. In 2014, Myint et al. conducted a prospective cohort study as well as meta-analysis to evaluate the relationship between
* Milija D. Mijajlovic [email protected] 1
Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, School of Medicine University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia
2
Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, Serbia
3
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
4
Brain Division, Shares Zedek Medical Center, Jerusalem, Israel
5
Shaare Zedek Medical Center, Jerusalem, Israel
BMD and stroke. Their study included 14,290 participants (mean follow-up of 9.3 years), with 599 cases of strokes. They found that a decrease of ~ 1 standard deviation in broadband ultrasound attenuation (20 db/MHz) was associated with a 17% increase in relative risk of stroke (95% confidence intervals, 5–30%). They conducted a search of EMBASE and MEDLINE and found 6 relevant studies for systematic review, of which 3 were suitable for the meta-analysis, along with their study. So, meta-analysis of 4 studies (25,760 study participants, 1237 stroke cases) found that for every decrease in 1 standard deviation in BMD, there was an increased risk of incident stroke among women (pooled relative risk 1.22; 95% confidence intervals, 1.09–1.37) but not in men (pooled relative ri
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