AMELIORATION OF HEMIPLEGIA-ASSOCIATED OSTEOPENIA MORE THAN 4 YEARS AFTER STROKE BY 1-ALPHA-HYDROXYVITAMIN D-3 AND CALCIUM SUPPLEMENTATION

Background and Purpose It has been demonstrated that bone mass was sig nificantly reduced on the hemiplegic side of stroke patients, which mi ght increase their risk of hip fracture. We evaluated the efficacy of 1 alpha-hydroxyvitamin D-3 [1 alpha(OH)D-3] and supplemental elemental calcium in maintaining bone mass and decreasing the incidence of hip fractures after hemiplegic stroke. Methods In a randomized study, 64 p atients with hemiplegia after stroke with a mean duration of illness o f 4.8 pears received either 1 mu g 1 alpha(OH)D-3 daily (treatment gro up, n = 30) or an inactive placebo (placebo group, n = 34) for 6 month s and were observed for this duration. Both groups received 300 mg of elemental calcium daily. The bone mineral density (BMD) and metacarpal index (MCI) in the second metacarpals were determined by computed x-r ay densitometry. The incidence of hip fractures in these patients was recorded. Results BMD on the hemiplegic side decreased by 2.4% in the treatment gaup and 8.9% in the placebo group (P = .0021), while BMD on the intact side increased by 3.5% and decreased by 6.3% in the treate d and placebo groups, respectively (P = .0177). In the treatment group , the difference in BMD between hemiplegic and nonhemiplegic sides dec reased significantly compared with that before randomization. This dif ference increased in the placebo group, We observed a similar improvem ent in MCI in the treatment group hut not in the placebo group. Four p atients in the placebo group suffered a hip fracture compared with non e in the treatment group (P = .0362). Conclusions Treatment with 1 alp ha(OH)D-3 and supplemental elemental calcium can reduce the risk of hi p fractures and can prevent further decreases in BMD and MCI on the he miplegic side of patients with a long-standing stroke. Treatment also may improve these indices on the intact side.