Radiographic Cortical Thickness of the Humerus in Detecting Post-Stroke Regional Bone Loss

NCT07651306 | Recruiting

• 1 other identifier: IstanbulPMRTRH5
• Study Type: observational
• Target: 65
• Locations: 1 country
• Sites: 1

Brief Summary

Post-stroke immobilization and reduced weight-bearing frequently lead to significant regional bone mineral density loss and asymmetry, particularly in the paretic upper extremity, which increases fracture risks. While Dual-Energy X-ray Absorptiometry (DXA) is the gold standard for evaluating systemic bone loss, it primarily focuses on axial or lower extremity sites and lacks universal accessibility. Since routine shoulder radiographs offer an opportunistic screening tool to evaluate regional bone quality without additional radiation , this study aims to compare proximal humerus cortical bone thickness between the paretic and non-paretic sides in stroke patients and assess its correlation with systemic DXA values to determine its clinical utility. This cross-sectional, observational study involves a retrospective data analysis of patients aged 18 and older who experienced a single unilateral stroke at least 6 months prior and present with clinical hemiparesis. Eligible participants must have concurrent standard anteroposterior shoulder radiographs and DXA measurements available from their routine clinical follow-ups. Patient demographic data, stroke characteristics, Brunnstrom stages, and systemic DXA measurements (femoral neck and lumbar spine T-scores and bone mineral density values) are systematically recorded for analysis. Cortical bone thickness measurements are performed using ImageJ software on standard radiographs at points 10 cm and 12 cm distal to the highest point of the humerus. To ensure reliability, measurements for both the paretic and non-paretic sides are conducted independently by two researchers who are completely blinded to the DXA results. Statistical analyses, including paired t-tests or Wilcoxon tests and Pearson or Spearman correlations, will be used to compare the sides and evaluate the relationship between radiographic cortical thickness and systemic bone density.

Conditions

Hemiparesis After Stroke; Dual Energy X-ray Absorptiometry; Osteoporosis

Keywords

Stroke; Cortical Bone Thickness; Osteoporosis; Radiography

Outcome Measures

Primary Outcomes (1)

• Difference in Proximal Humerus Cortical Bone Thickness Between Paretic and Non-Paretic Sides

  The average cortical bone thickness measured in millimeters on standard anteroposterior shoulder radiographs. Measurements are taken at exact locations 10 cm and 12 cm distal to the highest anatomical peak of the humerus on both the paretic and non-paretic sides to evaluate localized bone loss asymmetry.

  Baseline

Secondary Outcomes (2)

• Correlation Between Radiographic Cortical Bone Thickness and Systemic Bone Mineral Density

  Baseline

• Correlation Between Radiographic Cortical Bone Thickness and Systemic T-scores

  Baseline

Study Arms (1)

Poststroke Hemiparetic Individuals

This observational, retrospective cohort consists of hemiparetic adult patients aged 18 years and older who experienced a single, unilateral stroke at least 6 months prior. Selected participants must have concurrent systemic DXA measurements and standard anteroposterior shoulder radiographs taken within 6 months post-stroke from routine clinical follow-ups.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adults aged 18 years and older recruited from the clinics of Istanbul Physical Medicine and Rehabilitation Training and Research Hospital. Participants will include hemiparetic individuals with a history of a single unilateral stroke occurring at least 6 months prior, who possess concurrent standard shoulder radiographs and systemic dual-energy X-ray absorptiometry measurements.

You may qualify if:

• Patients aged 18 years and older.
• A documented history of a single unilateral stroke that occurred at least 6 months prior to evaluation.
• Presence of clinical hemiparesis.
• Availability of concurrent standard anteroposterior (AP) shoulder radiographs taken within 6 months post-stroke alongside systemic DXA measurements.

You may not qualify if:

• History of surgical intervention in either shoulder. History of a proximal humerus fracture.
• Co-existing metabolic bone diseases, such as primary hyperparathyroidism or osteomalacia.
• History of malignancy.
• Documented history of corticosteroid use.
• Imaging artifacts that compromise the accuracy of DXA measurements.
• History of a secondary stroke.

Sponsors & Collaborators

• Istanbul Physical Medicine Rehabilitation Training and Research Hospital: lead

Study Sites (1)

Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Istanbul, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Osteoporosis; Stroke

Condition Hierarchy (Ancestors)

Bone Diseases, Metabolic; Bone Diseases; Musculoskeletal Diseases; Metabolic Diseases; Nutritional and Metabolic Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Central Study Contacts

Ismet Alkim Ozkan MD

CONTACT

+905356350591; dr.alkimozkan@gmail.com

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Specialist in Physical Medicine and Rehabilitation

Study Record Dates

• First Submitted: June 10, 2026
• First Posted: June 16, 2026
• Study Start: February 22, 2026
• Primary Completion: June 25, 2026
• Study Completion: July 1, 2026
• Last Updated: June 16, 2026

Record last verified: 2026-06

Locations

TU (1)