Beneficial Effect of Etidronate Therapy in Chronically Hospitalized, Disabled Patients with Stroke

Incidence of hip fractures is high in chronically hospitalized, disabled, elderly patients after stroke. Duration of hospitalization was more than 1 year because of insufficiency of nursing homes. Our study showed that immobilization-induced hypercalcemia and 25-hydroxyvitamin D deficiency contribute to reduced bone mineral density (BMD). This study was designed to address the possibility that treatment with etidronate may reduce the bone resorption and lower the incidence of fractures in elderly patients who are chronically hospitalized and disabled as a result of hemiparesis after stroke. Patients with stroke were randomly assigned to daily treatment with 400 mg of etidronate (n = 40) or a placebo (n = 40), and followed up for 2 years. At baseline, both groups had low BMD with high levels of serum ionized calcium and urinary deoxypyridinoline. In the etidronate group, serum calcium and urinary deoxypyridinoline levels decreased significantly during the study period, whereas the levels in the placebo group were increased. BMD on the hemiplegic side increased by 1.4% in the etidronate group and decreased by 2.2% in the placebo group (P < .001). Two patients sustained hip fractures in the placebo group, and no hip fracture occurred in the etidronate group. Treatment with etidronate increases BMD in chronically hospitalized patients poststroke, and may prevent hip fracture.