Adults with polio are at risk of hip fracture from middle age: A nationwide population-based cohort study.

BACKGROUND: Having motor impairment since childhood and being at risk of osteoporosis and falls, adults with polio would be more likely to suffer a hip fracture (HF) and may experience different epidemiological characteristics from the general population. OBJECTIVE: To estimate the risk and incidence of HF in adults with polio. DESIGN: Using a national database, we conducted a population-based cohort study. We identified patients with polio using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 138. For each patient with polio, we randomly selected five age- and sex-matched control subjects. Those subjects aged <40 years were excluded. We analyzed participants aged 40˜64 years (middle-aged) and subjects aged ≥65 years (elderly) separately and recognized subjects who had an HF (ICD-9-CM code, 820) only when they received hospitalization to care for the illness from January 1, 2003 to December 31, 2008. RESULTS: We identified 403 adults with polio (mean age ± standard deviation, 47.2 ± 8.6 years). Compared to the controls, patients with polio had a higher incidence of HF (all, 4.1 vs. 1.1/1000 person-years, p = 0.002; middle-aged, 2.3 vs. 0.3/1000 person-years, p < 0.001; male, 6.2 vs. 0.9/1000 person-years, p < 0.001); had a younger mean age (±standard deviation) of fracturing a hip (61.0±14.9 vs. 74.4±9.3 years, p = 0.015); had a lower cumulative HF-free probability (±standard error) before the age of 65 years (0.970±0.017 vs. 0.988±0.007, p<0.001) and throughout the study duration (0.415 ± 0.296 vs. 0.682 ± 0.158, p<0.001); and had a higher risk of HF, yielding an adjusted hazard ratio (95% confidence interval) of 3.58 (1.45˜8.79, p = 0.006). Patients with polio aged >48.2 years were likely to experience an HF. CONCLUSIONS: Adults with polio are at risk of HF. A customized HF prevention program is important for people with polio. The program should be started early in middle-age and should include men.

Femoral neck bone mineral density change is associated with shift in standing weight in hemiparetic stroke patients.

OBJECTIVE: The aim of this study was to explore the association between the proportion of body weight bearing of the paretic leg and the rate of femoral neck bone mineral density loss in acute first-ever stroke patients. DESIGN: Patients were divided into those bearing less weight (<50%) on the paretic leg (n = 11) and those bearing more weight (≥50%) on the paretic leg (n = 11). The change in bone mineral density (grams per square centimeter per year) was calculated from the initial and follow-up dual-energy x-ray absorptiometry (≥6 mos). The proportion of body weight bearing was calculated from the body weight bearing of each leg, which was measured with the patient standing on a tilt table. RESULTS: Compared with the patients bearing more weight on the paretic leg, the patients bearing less weight on the paretic leg had faster reduction in femoral neck bone mineral density. The proportion of body weight bearing was associated with the change in bone mineral density in the paretic (adjusted r = 51.0%, P < 0.001) and nonparetic (adjusted r = 32.4%, P < 0.005) legs. CONCLUSIONS: The stroke patients with proportion of body weight bearing of less than 50% on the paretic leg experienced faster bone loss and compromised bone density in the femoral neck. The proportion of body weight bearing may be useful to estimate the change in bone mineral density in paretic legs within the first year after stroke.

Subdural hygroma-related heterotopic ossification in a patient with a stroke: a case report.

BACKGROUND: This study presents a patient with a stroke who had total paralysis of his left-side limbs after intracranial haemorrhaging, who later experienced partial weakness of the right-side limbs after a subdural hygroma. Both conditions occurred without major trauma. He received two separate operations, a craniotomy and placement of a ventriculoperitoneal shunt, before the appearance of the subdural hygroma. CASE STUDY: According to the literature, heterotopic ossification is often reported with major trauma-associated diseases, but is less frequently found in patients with non-traumatic conditions, from which this patient suffered. Although the patient had experienced no major trauma, he had multiple heterotopic ossifications on the side of the subdural hygroma-affected limbs, which exhibited better motor control and were less spastic than those of the opposite side. These heterotopic ossifications were around joints of the hip, knee and shoulder on his right side, as proven by plain radiography and a triple-phase bone scan and resulted in marked limitations of joint motions. This patient thus had major disabilities of his limbs bilaterally. CONCLUSIONS: The occurrence of heterotopic ossifications in the less-paretic limbs might have worsened this patient's functional outcome.