Amelioration of Hemiplegia-Associated Osteopenia More Than 4 Years After Stroke by 1α-Hydroxyvitamin D3 and Calcium Supplementation

Background and Purpose It has been demonstrated that bone mass was significantly reduced on the hemiplegic side of stroke patients, which might increase their risk of hip fracture. We evaluated the efficacy of 1α-hydroxyvitamin D3 [1α(OH)D3] and supplemental elemental calcium in maintaining bone mass and decreasing the incidence of hip fractures after hemiplegic stroke. Methods In a randomized study, 64 patients with hemiplegia after stroke with a mean duration of illness of 4.8 years received either 1 μg 1α(OH)D3 daily (treatment group, n=30) or an inactive placebo (placebo group, n=34) for 6 months 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-ray densitometry. The incidence of hip fractures in these patients was recorded. Results BMD on the hemiplegic side decreased by 2.4% in the treatment group 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 treated and placebo groups, respectively ( P =.0177). In the treatment group, the difference in BMD between hemiplegic and nonhemiplegic sides decreased significantly compared with that before randomization. This difference increased in the placebo group. We observed a similar improvement in MCI in the treatment group but not in the placebo group. Four patients in the placebo group suffered a hip fracture compared with none in the treatment group ( P =.0362). Conclusions Treatment with 1α(OH)D3 and supplemental elemental calcium can reduce the risk of hip fractures and can prevent further decreases in BMD and MCI on the hemiplegic side of patients with a long-standing stroke. Treatment also may improve these indices on the intact side.