High-resolution peripheral quantitative computed tomography imaging and bone biomarker characteristics of patients with ischemic stroke or transient ischemic attack-baseline analysis of the Post-stroke Osteopathy study.
Dejakum B, Bereiter-Payr J, et al. • Archives of osteoporosis • 2026
This study provides the first combined HR-pQCT imaging and bone biomarker characterization of bone structural and biochemical properties in a stroke/TIA cohort, finding that sex, age, smoking, BMI, sclerostin, osteoprotegerin, and osteocalcin are all associated with distinct bone parameters.
Key Findings
Results
Women with stroke or TIA had lower total, cortical, and trabecular volumetric bone mineral density (vBMD) and lower values for most other HR-pQCT parameters compared to men.
HR-pQCT scans were performed at both the radius and tibia within the first days after the acute cerebrovascular event
Sex differences were observed across total, cortical, and trabecular vBMD measurements
The differences extended to most other HR-pQCT structural parameters beyond vBMD
This was a cross-sectional baseline analysis of a prospective cohort study
Results
Increasing age in stroke/TIA patients was associated with lower total and cortical vBMD, but not with differences in trabecular parameters.
Age-related bone loss appeared to be compartment-specific, affecting cortical bone more than trabecular bone
Both total and cortical vBMD declined with age
Trabecular vBMD and trabecular structural parameters were not significantly different with increasing age
Measurements were taken at the radius and tibia using HR-pQCT
Results
Active or former smokers with stroke or TIA had lower total and trabecular vBMD compared to non-smokers.
Smoking status was categorized as active, former, or never smoker
The association was observed specifically for total and trabecular vBMD
Cortical vBMD was not reported as significantly different between smoking groups
This finding suggests a trabecular-predominant effect of smoking on bone in this cerebrovascular population
Results
Higher BMI was associated with greater cortical and trabecular bone areas and higher trabecular density in stroke/TIA patients.
BMI showed a positive association with bone structural parameters
Both cortical and trabecular bone areas were larger in patients with higher BMI
Trabecular density was also positively associated with higher BMI
This finding is consistent with the known mechanical loading effects of body weight on bone structure
Results
Sclerostin levels showed a positive correlation with trabecular bone parameters in stroke/TIA patients.
Sclerostin is a Wnt signaling inhibitor produced by osteocytes that regulates bone formation
The positive correlation was specifically observed with trabecular parameters
Sclerostin was among a panel of biochemical bone biomarkers evaluated alongside HR-pQCT imaging
This represents one of the first characterizations of sclerostin in relation to bone structure in a stroke/TIA cohort
Results
Higher osteoprotegerin levels were associated with lower cortical area and cortical thickness in stroke/TIA patients.
Osteoprotegerin is a decoy receptor for RANKL that inhibits osteoclast differentiation
The inverse association was found specifically for cortical bone compartment parameters
Both cortical area and cortical thickness showed negative associations with osteoprotegerin levels
Biochemical bone marker evaluation was performed within the first days after the acute cerebrovascular event
Results
Osteocalcin showed a negative correlation with total vBMD and cortical thickness in stroke/TIA patients.
Osteocalcin is a bone formation marker secreted by osteoblasts
The negative correlation with total vBMD suggests that higher bone turnover may be associated with lower bone density in this population
Cortical thickness specifically showed a negative association with osteocalcin levels
This finding may reflect uncoupled or elevated bone remodeling activity in the post-stroke setting
Background
This study is the first to combine HR-pQCT imaging with bone biomarkers to characterize bone structural and biochemical properties in a stroke/TIA cohort.
HR-pQCT scans were performed at both the radius and tibia
The study design was a cross-sectional baseline analysis of a prospective cohort called the Post-stroke Osteopathy study
Assessments were conducted within the first days after the acute cerebrovascular event
Biochemical bone marker evaluation included sclerostin, osteoprotegerin, and osteocalcin among others
The authors state these findings 'lay the foundation for a comprehensive understanding of post-stroke osteopathy and its clinical implications'
What This Means
This research suggests that people who have had a stroke or transient ischemic attack (TIA, or 'mini-stroke') show distinct patterns in their bone structure and bone-related blood markers. Using a highly detailed type of bone scanning called HR-pQCT — which can measure the density and architecture of different layers of bone — along with blood tests for bone proteins, researchers found that factors like sex, age, smoking history, and body weight are each linked to specific aspects of bone quality in this patient group. For example, women had lower bone density across all bone compartments, older patients had weaker cortical (outer shell) bone but not necessarily weaker inner spongy bone, and smokers tended to have lower density in the inner spongy (trabecular) bone.
The study also found important links between specific bone proteins in the blood and bone structure. Higher levels of sclerostin — a protein that slows bone building — were linked to certain trabecular bone features, while higher levels of osteoprotegerin were linked to thinner cortical bone. Osteocalcin, a marker of bone formation activity, was unexpectedly negatively linked to overall bone density and cortical thickness, which may suggest abnormal bone remodeling after a stroke. These findings are notable because stroke patients are known to be at high risk of fractures, which can worsen health outcomes and quality of life.
This research matters because it is the first study to use both detailed bone imaging and blood biomarkers together in stroke and TIA patients so soon after the event. This research suggests that the bone changes following stroke are complex and affect different compartments of bone in different ways depending on a patient's characteristics. Understanding these patterns could eventually help clinicians identify which stroke patients are at greatest risk for bone loss and fractures, and might guide future research into treatments that protect bone health after a cerebrovascular event.
Dejakum B, Bereiter-Payr J, Felicetti S, Moelgg K, Karisik A, Degenhart G, et al.. (2026). High-resolution peripheral quantitative computed tomography imaging and bone biomarker characteristics of patients with ischemic stroke or transient ischemic attack-baseline analysis of the Post-stroke Osteopathy study.. Archives of osteoporosis. https://doi.org/10.1007/s11657-026-01767-w