Abstract
Falls are a common and serious, but potentially preventable, problem after stroke. Avoiding falls requires balance, which is a fluid and dynamic physical skill. There are a number of perceptual, neurological, and mechanical mechanisms underlying our ability to balance, and they are complex and heterogeneous. Depending on where strokes occur in the brain, balance may be affected in different ways. It is important to identify stroke patients who are at risk of falls in order to optimize prevention, and a number of stroke-specific risk factors have been identified, but the available assessment scales have only limited sensitivity and specificity. If management of falls risk in stroke is to be effective, assessments have to identify the precise and individual mechanisms underlying balance problems, and then specific management has to be targeted at these deficits. The consequences of falls after stroke can be severe and include loss of confidence and loss of independence, as well as serious injury including fractures. Stroke patients are at greater risk of osteoporosis, particularly on the hemiplegic side, which occurs rapidly following paresis. Management of falls risk post-stroke should also include timely assessment of bone health and the associated fracture risk.
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References
Nyberg L, Gustafson Y. Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke. 1995;26:838–42.
Davenport RJ, Dennis MS, Wellwood I, Warlow CP. Complications after acute stroke. Stroke. 1996;27:415–20.
Teasell R, McRae M, Foley N, Bhardwaj A. The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. Arch Phys Med Rehabil. 2002;83:329–33.
Suzuki T, Sonoda S, Misawa K, Saitoh E, Shimizu Y, Kotake T. Incidence and consequence of falls in inpatient rehabilitation of stroke patients. Exp Aging Res. 2005;31:457–69.
Chaiwanichsiri D, Jiamworakul A, Kitisomprayoonkl W. Falls among stroke patients in Thai Red Cross rehabilitation center. J Med Assoc Thai. 2006;89:S47–52.
Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ. 1995;311:83–6.
Kerse N, Parag V, Feigin VL, McNaughton H, Hackett ML, Bennett DA, et al. Auckland Regional Community Stroke (ARCOS) Study Group. Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) study, 2002–2003. Stroke. 2008;39:1890–3.
Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;87:1583–9.
Mackintosh SFH, Hill K, Dodd KJ, Goldie P, Culham E. Falls and injury prevention should be part of every stroke rehabilitation plan. Clin Rehabil. 2005;19:441–51.
Mackintosh SFH, Goldie P, Hill K. Falls incidence and factors associated with falling in older, community-dwelling, chronic stroke survivors (>1 year after stroke) and matched controls. Aging Clin Exp Res. 2005;17:74–81.
Jørgensen L, Engstad T, Jacobsen BK. Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke. 2002;33:542–7.
Tutuarima JA, van der Meulen JHP, de Haan RJ, van Straten A, Limburg M. Risk factors for falls of hospitalized stroke patients. Stroke. 1997;28:297–301.
Aizen E, Shugaev I, Lenger R. Risk factors and characteristics of falls during inpatient rehabilitation of elderly patients. Arch Gerontol Geriatr. 2007;44:1–12.
Sze KH, Wong E, Leung HY, Woo J. Falls among Chinese stroke patients during rehabilitation. Arch Phys Med Rehabil. 2001;82:1219–25.
Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil. 2002;83:165–70.
Gücüyener D, Ugur C, Uzuner N, Özdemir G. The importance of falls in stroke patients. Ann Saudi Med. 2000;20:322–3.
Thapa PB, Gideon P, Brockman KG, Fought RL, Ray WA. Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents. J Gerontol A Biol Sci Med Sci. 1996;51:M239–46.
Lee DN, Lishman JR. Visual proprioceptive control of stance. J Hum Mov Stud. 1975;1:87–95.
Darowski A, Chambers SA, Chambers DJ. Antidepressants and falls in the elderly. Drugs Aging. 2009;26:381–94.
Ugur C, Gücüyener D, Uzuner N, Özkan S, Özdemir G. Characteristics of falling patients with stroke. J Neurol Neurosurg Psychiatry. 2000;69:649–51.
Hyndman D, Ashburn A. People with stroke living, in the community: attention deficits, balance, ADL ability and falls. Disabil Rehabil. 2003;25:817–22.
Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil. 2006;87:554–61.
Soyuer F, Ozturk A. The effect of spasticity, sense and walking aids in falls of people after chronic stroke. Disabil Rehabil. 2007;29:679–87.
Schmid AA, Wells CK, Concato J, Dallas MI, Lo AC, Nadeau SE, et al. Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting. J Rehabil Res Dev. 2010;47:553–62.
Yates JS, Lai SM, Duncan PW, Studenski S. Falls in community-dwelling stroke survivors: an accumulated impairments model. J Rehabil Res Dev. 2002;39:385–94.
Andersson AG, Kamwendo K, Seiger A, Appleros P. How to identify potential fallers in a stroke unit: validity indexes of four test methods. J Rehabil Med. 2006;38:186–91.
Czernuszenko A. Risk factors for falls in post-stroke patients treated in a neurorehabilitation ward. Neurol Neurochir Pol. 2007;41:28–35.
Tilson JK, Wu SS, Cen SY, Feng Q, Rose DR, Behrman AL, et al. Characterizing and identifying risk for falls in the LEAPS study: a randomized clinical trial of interventions to improve walking poststroke. Stroke. 2012;43:446–52.
Maeda N, Kato J, Shimada T. Predicting the probability for fall incidence in stroke patients using the Berg Balance Scale. J Int Med Res. 2009;37:697–704.
Smith J, Forster A, Young J. Use of the ‘STRATIFY’ falls risk assessment in patients recovering from acute stroke. Age Ageing. 2006;35:138–43.
Nyberg L, Gustafson Y. Using the Downton index to predict those prone to falls in stroke rehabilitation. Stroke. 1996;27:1821–4.
Rapport LJ, Webster JS, Flemming KL, Lindberg JW, Godlewski MC, Brees JE, et al. Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting. Arch Phys Med Rehabil. 1993;74:621–6.
Hyndman D, Ashburn A. Stops walking when talking as a predictor of falls in people with stroke living in the community. J Neurol Neurosurg Psychiatry. 2004;75:994–7.
Nyberg L, Gustafson Y. Fall prediction index for patients in stroke rehabilitation. Stroke. 1997;28:716–21.
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM. Interventions for preventing falls in older people living in the community. Cochrane Collab Cochrane Database Syst Rev. 2012;9:CD007146.
Batchelor FA, Mackintosh SF, Said CM, Hill KD. Falls after stroke. Int J Stroke. 2012;7:482–90.
Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A Very Early Rehabilitation Trial for Stroke (AVERT): phase II safety and feasibility. Stroke. 2008;39:390–6.
Barreca S, Sigouin CS, Lambert C, Ansley B. Effects of extra training on the ability of stroke survivors to perform an independent sit-to-stand: a randomized controlled trial. J Geriatr Phys Ther. 2004;27:59–68.
Cheng PT, Wu SH, Liaw MY, Wong AMK, Tang FT. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil. 2001;82:1650–4.
Green J, Forster A, Bogle S, Young J. Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial. Lancet. 2002;359:199–203.
Marigold DS, Eng JJ, Dawson AS, Inglis JT, Harris JE, Gylfadottir S. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. J Am Geriatr Soc. 2005;53:416–23.
Yelnik AP, Le Breton F, Colle FM, Bonan IV, Hugeron C, Egal V, et al. Rehabilitation of balance after stroke with multisensorial training: a single-blind randomized controlled study. Neurorehabil Neural Repair. 2008;22:468–76.
Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, et al., LEAPS Investigative Team. Body-weight supported treadmill rehabilitation after stroke. N Engl J Med. 2011;364:2026–36.
Sato Y, Iwamoto J, Kanoko T, Satoh K. Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovasc Dis. 2005;20:187–92.
Sato Y, Iwamoto J, Honda Y. An open-label trial comparing alendronate and alphacalcidol in reducing falls and hip fractures in disabled stroke patients. J Stroke Cerebrovasc Dis. 2011;20:41–6.
Sato Y, Iwamoto J, Kanoko T, Satoh K. Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke. Arch Intern Med. 2005;165:1743–8.
Sato Y, Iwamoto J, Kanoko T, Satoh K. Risedronate therapy for prevention of hip fracture after stroke in elderly women. Neurology. 2005;64:811–6.
Pollock A, Hazelton C, Henderson CA, Angilley J, Dhillon B, Langhorne P, et al. Interventions for disorders of eye movement in patients with stroke. Cochrane Database Syst Rev. 2011;(10):CD008389.
Voigt-Radloff S, Ruf G, Vogel A, van Nes F, Hull M. Occupational therapy for elderly; evidence mapping of randomised controlled trials from 2004–2012. Z Gerontol Geriatr. 2015;48(1):52–72.
Schmid AA, Van Puymbroeck M, Knies K, Spangler-Morris C, Watts K, Damush T, et al. Fear of falling among people who have sustained a stroke: a 6-month longitudinal pilot study. J Occup Ther. 2011;65:125–32.
Zijlstra GA, van Haastregt JC, Ambergen T, van Rossum E, van Eijk JT, Tennstdet SL, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc. 2009;57:2020–8.
Jayakody K, Gundasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014;48:187–96.
Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med. 1999;159:677–85.
Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW. Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med. 2005;118:612–7.
Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmauriceb D, Lip GY, et al. Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370:493–503.
Donze J, Clair C, Hug B, Rodoni N, Waeber G, Cornuz J, Aujesky D. Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med. 2012;125:773–8.
Carda S, Cisari C, Invernizzi M, Bevilacqua M. Osteoporosis after stroke: a review of the causes and potential treatments. Cerebrovasc Dis. 2009;28:191–200.
Wu CH, Liou TH, Hsiao PL, Lin YC, Chang KH. Contribution of ischemic stroke to hip fracture risk and the influence of gender difference. Arch Phys Med Rehabil. 2011;92:1987–91.
Kanis J, Oden A, Johnell O. Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke. 2001;32:702–6.
Dennis MS, Lo KM, McDowall M, West T. Fractures after stroke: frequency, types, and associations. Stroke. 2002;33:728–34.
Brown DL, Morgenstern LB, Majersik JJ, Kleerekoper M, Lisabeth LD. Risk of fractures after stroke. Cerebrovasc Dis. 2008;25:95–9.
Ramnemark A, Nilsson M, Borssen B, Gustafson Y. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke. 2000;31:1572–7.
Ramnemark A, Nyberg L, Borssen B, Olsson T, Gustafason Y. Fractures after stroke. Osteoporos Int. 1998;8:92–5.
Fisher A, Srikusalanukul W, Davis M, Smith P. Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention. Stroke Res Treat. 2013;2013:641943.
Mundi S, Pindiprolu B, Simunovic N, Bhandari M. Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop. 2014;85:54–9.
Pouwels S, Lalmohamed A, Leufkens B, de Boer A, Cooper C, van Staa T, et al. Risk of hip/femur fracture after stroke: a population-based case-control study. Stroke. 2009;40:3281–5.
Myint PK, Clark AB, Kwok CS, Loke YK, Yeong JK, Luben RN, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer–Norfolk population-based study, systematic review, and meta-analysis. Stroke. 2014;45:373–82.
Poole KE, Loveridge N, Rose CM, Warburton EA, Reeve J. A single infusion of zoledronate prevents bone loss after stroke. Stroke. 2007;38:1519–25.
Hamdy RC, Moore SW, Cancellaro V, Harvill L. Long-term effect of strokes on bone mass. Am J Phys Rehabil. 1995;74:351–6.
Paker N, Bugdayci D, Tekdos D, Dere C, Kaya B. Relationship between bone turnover and bone density at the proximal femur in stroke patients. J Stroke Cerebrovasc Dis. 2009;18:139–43.
Frotzler A, Berger M, Knecht H, Eser P. Bone steady-state is established at reduced bone strength after spinal cord injury: a longitudinal study using peripheral quantitative computed tomography (pQCT). Bone. 2008;43:549–55.
Lazoura O, Groumas N, Antoniadou E, Papadaki PJ, Papadimitriou A, Thriskos P, et al. Bone mineral density alterations in upper and lower extremities 12 months after stroke measured by peripheral quantitative computed tomography and DXA. J Clin Densitom. 2008;11:511–7.
Schnitzer TJ, Harvey RL, Nack SH, Supanwanid P, Maskala-Streff L, Roth E. Bone mineral density in patients with stroke: relationship with motor impairment and functional mobility. Top Stroke Rehabil. 2012;19:436–43.
Jørgensen L, Jacobsen BK, Wilsgaard T, Magnus JH. Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study. Osteoporos Int. 2000;11:381–7.
Chang KH, Liou TH, Sung JY, Wang CY, Genant HK, Chan WP. Femoral neck bone mineral density change is associated with shift in standing weight in hemiparetic stroke patients. Am J Phys Med Rehabil. 2014;93:477–85.
Kazakia GJ, Tjong W, Nirody JA, Burghardt AJ, Carballido-Gamio J, Patsch JM, Link T, Feeley BT, Ma CB. The influence of disuse on bone microstructure and mechanics assessed by HR-pQCT. Bone. 2014;63:132–40.
Borschmann K, Pang MY, Iuliano S, Churilov L, Brodtmann A, Ekinci EI, Berhardt J. Changes to volumetric bone mineral density and bone strength after stroke: a prospective study. Int J Stroke. 2015;10(3):396–9.
Tatsumi S, Ishii K, Amizuka N, Li M, Kobayashi T, Kohno K, Ito M, Takeshita S, Ikeda K. Targeted ablation of osteocytes induces osteoporosis with defective mechanotransduction. Cell Metab. 2007;5:464–75.
Buo AM, Stains JP. Gap junctional regulation of signal transduction in bone cells. FEBS Lett. 2014;588:1315–21.
Schaffler MB, Cheung WY, Majeska R, Kennedy O. Osteocytes: master orchestrators of bone. Calcif Tissue Int. 2014;94:5–24.
Klein-Nulend J, Bakker AD, Bacabac RG, Vatsa A, Weinbaum S. Mechanosensation and transduction in osteocytes. Bone. 2013;54:182–90.
Xiong J, Onal M, Jilka RL, Weinstein RS, Manolagas SC, O’Brien CA. Matrix-embedded cells control osteoclast formation. Nat Med. 2011;17:1235–41.
Gaudio A, Pennisi P, Bratengeier C, Torrisi V, Lindner B, Mangiafico RA, et al. Increased sclerostin serum levels associated with bone formation and resorption markers in patients with immobilization-induced bone loss. J Clin Endocrinol Metab. 2010;95:2248–53.
Robinson JA, Chatterjee-Kishore M, Yaworsky PJ, Cullen DM, Zhao W, Li C, et al. Wnt/beta-catenin signaling is a normal physiological response to mechanical loading in bone. J Biol Chem. 2006;281:31720–8.
Burgers TA, Williams BO. Regulation of Wnt/β-catenin signaling within and from osteocytes. Bone. 2013;54:244–9.
Spatz JM, Ellman R, Cloutier AM, Louis L, van Vliet M, Suva LJ, et al. Sclerostin antibody inhibits skeletal deterioration due to reduced mechanical loading. J Bone Miner Res. 2013;28:865–74.
McClung MR, Grauer A, Boonen S, Bolognese MA, Brown JP, Diez-Perez A, et al. Romosozumab in postmenopausal women with low bone mineral density. N Engl J Med. 2014;370:412–20.
Sato Y, Metoki N, Iwamoto J, Satoh K. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology. 2003;61:338–42.
Sato Y, Kaji M, Honda Y, Hayashida N, Iwamoto J, Kanoko T, et al. Abnormal calcium homeostasis in disabled stroke patients with low 25-hydroxyvitamin D. Bone. 2004;34:710–5.
Bikle DD, Halloran BP. The response of bone to unloading. J Bone Miner Metab. 1999;17:233–44.
Seibel MJ, Robins SP, Bilezikian JP. Serum undercarboxylated osteocalcin and the risk of hip fracture. J Clin Endocrinol Metab. 1997;82:717–8.
Usui Y, Tanimura H, Nishimura N, Kobayashi N, Okanoue T, Ozawa K. Vitamin K concentrations in the plasma and liver of surgical patients. Am J Clin Nutr. 1990;51:846–52.
Sato Y, Tsuru T, Oizumi K, Kaji M. Vitamin K deficiency and osteopenia in disuse-affected limbs of vitamin D-deficient elderly stroke patients. Am J Phys Med Rehabil. 1999;78:317–22.
Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr. 1999;69:74–9.
Cagnacci A, Bagni B, Zini A, Cannoletta M, Generali M, Volpe A. Relation of folates, vitamin B12 and homocysteine to vertebral bone mineral density change in postmenopausal women. A five-year longitudinal evaluation. Bone. 2008;42:314–20.
Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. JAMA. 2005;293:1082–8.
Gommans J, Yi Q, Eikelboom JW, Hankey GJ, Chen C, Rodgers H, et al. The effect of homocysteine-lowering with B-vitamins on osteoporotic fractures in patients with cerebrovascular disease: substudy of VITATOPS, a randomised placebo-controlled trial. BMC Geriatr. 2013;13:88.
Sato Y, Honda Y, Kunoh H, Oizumi K. Long-term oral anticoagulation reduces bone mass in patients with previous hemispheric infarction and nonrheumatic atrial fibrillation. Stroke. 1997;28:2390–4.
Gage BF, Birman-Deych E, Radford MJ, Nilasena DS, Binder EF. Risk of osteoporotic fracture in elderly patients taking warfarin: results from the National Registry of Atrial Fibrillation 2. Arch Intern Med. 2006;166:241–6.
Misra D, Zhang Y, Peloquin C, Choi HK, Kiel DP, Neogi T. Incident long-term warfarin use and risk of osteoporotic fractures: propensity-score matched cohort of elders with new onset atrial fibrillation. Osteoporos Int. 2014;25:1677–84.
Pettilä V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost. 2002;87:182–6.
Phabphal K, Geater A, Limapichat K, Sathirapanya P, Setthawatcharawanich S, Leelawattana R. Effect of switching hepatic enzyme-inducer antiepileptic drug to levetiracetam on bone mineral density, 25 hydroxyvitamin D, and parathyroid hormone in young adult patients with epilepsy. Epilepsia. 2013;54:e94–8.
Salimipour H, Kazerooni S, Seyedabadi M, Nabipour I, Nemati R, Iranpour D, et al. Antiepileptic treatment is associated with bone loss: difference in drug type and region of interest. J Nucl Med Technol. 2013;41:208–11.
Khalili H, Huang ES, Jacobson BC, Camargo Jr CA, Feskanich D, Chan AT. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ. 2012;344:e372.
Ding J, Heller DA, Ahern FM, Brown TV. The relationship between proton pump inhibitor adherence and fracture risk in the elderly. Calcif Tissue Int. 2014;94:597–607.
Colón-Emeric C, O’Connell MB, Haney E. Osteoporosis piece of multi-morbidity puzzle in geriatric care. Mt Sinai J Med. 2011;78:515–26.
Borschmann K. Exercise protects bone after stroke, or does it? A narrative review of the evidence. Stroke Res Treat. 2012;2012:103697.
Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ. 2012;344:e3427.
Rabar S, Lau R, O’Flynn N, Li L, Barry P, Guideline Development Group. Risk assessment of fragility fractures: summary of NICE guidance. BMJ. 2012;345:e3698.
Coughlan T, Dockery F. Osteoporosis and fracture risk in older people. Clin Med. 2014;14:187–91.
Pang MY, Lau RW, Yip SP. The effects of whole-body vibration therapy on bone turnover, muscle strength, motor function, and spasticity in chronic stroke: a randomized controlled trial. Eur J Phys Rehab Med. 2013;49:439–50.
Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int. 2010;21:1121–32.
Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart. 2012;98:920–5.
Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011;342:d2040.
National Osteoporosis Society. Vitamin D and bone health: a practical clinical guideline for patient management; 2013. www.nos.org.
National Osteoporosis Foundation Clinician’s Guide to Prevention and Treatment of Osteoporosis. http://nof.org/hcp/clinicians-guide.
Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303:1815–22.
Sato Y, Honda Y, Kuno H, Oizumi K. Menatetrenone ameliorates osteopenia in disuse-affected limbs of vitamin D- and K-deficient stroke patients. Bone. 1998;23:291–6.
Sato Y, Kuno H, Kaji M, Saruwatari N, Oizumi K. Effect of ipriflavone on bone in elderly hemiplegic stroke patients with hypovitaminosis D. Am J Phys Med Rehabil. 1999;78:457–63.
Alexandersen P, Toussaint A, Christiansen C, Devogelaer JP, Roux C, Fechtenbaum J, et al. Ipriflavone multicenter European fracture study “ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial”. JAMA. 2001;285:1482–8.
Levi S, Lagari VS. The old of diet in osteoporosis prevention and management. Curr Osteoporos Rep. 2012;10:296–302.
Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provides new insights into osteoporosis. Endocrine. 2014;46:397–405.
Ikai T, Uematsu M, Eun SS, Kimura C, Hasegawa C, Miyano S. Prevention of secondary osteoporosis postmenopause in hemiplegia. Am J Phys Med Rehabil. 2001;80:169–74.
Turner RT, Evans GL, Lotinun S, Lapke PD, Iwaniec UT, Morey-Holton E. Dose-response effects of intermittent PTH on cancellous bone in hindlimb unloaded rats. J Bone Miner Res. 2007;22:64–71.
Agholme F, Isaksson H, Li X, Ke HZ, Aspenberg P. Anti-sclerostin antibody and mechanical loading appear to influence metaphyseal bone independently in rats. Acta Orthop. 2011;82:628–32.
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Dockery, F., Sommerville, P.J. (2015). Falls and Osteoporosis Post-Stroke. In: Bhalla, A., Birns, J. (eds) Management of Post-Stroke Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-17855-4_11
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