{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T21:46:33Z","timestamp":1770414393900,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T00:00:00Z","timestamp":1553472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Literature indicates that individuals with long\u2010term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) related to muscle weakness. Where weakness is asymmetrical, bone densitometry measured only on the stronger LE may misclassify BMD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient postpolio center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Patients &gt;18\u2009years old with complete relevant data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Bone densitometry T scores, BMD categories based on standard T\u2010score ranges, and side of LE weakness determined by a strength score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010three patients had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had bone densitometry only on their weaker LE and 14 (32.5%) had bone densitometry only on their stronger LE. Of the 15 patients with bone densitometry done on both femoral necks, T scores (mean [SD]) were lower in the weaker LE (\u22121.73 [1.09]) than the stronger LE (\u22120.88 [1.0]) (<jats:italic>P<\/jats:italic>\u2009=\u2009.001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this small sample, using strong\u2010limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak\u2010limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high\u2010fall\u2010risk group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>III<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2018.08.387","type":"journal-article","created":{"date-parts":[[2018,9,7]],"date-time":"2018-09-07T08:11:15Z","timestamp":1536307875000},"page":"470-475","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bone Mineral Density Among Individuals With Residual Lower Limb Weakness After Polio"],"prefix":"10.1002","volume":"11","author":[{"given":"Beth","family":"Grill","sequence":"first","affiliation":[{"name":"Spaulding Outpatient Center Framingham  MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela K.","family":"Levangie","sequence":"additional","affiliation":[{"name":"MGH Institute of Health Professions Boston, MA; and 500 Lexington Street, Unit 3 Woburn, MA 01801"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Cole","sequence":"additional","affiliation":[{"name":"Spaulding Outpatient Center Framingham  MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Spaulding Outpatient Center Framingham  MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Jensen","sequence":"additional","affiliation":[{"name":"Spaulding Outpatient Center Framingham  MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,25]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Post\u2010polio fact sheet.2017. Available at:https:\/\/www.ninds.nih.gov\/Disorders\/Patient-Caregiver-Education\/Fact-Sheets\/Post-Polio-Syndrome-Fact-Sheet. Accessed March 8 2018."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.5897\/JIDI11.047"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2006.01385.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.05.010"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000242444"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200208000-00002"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0620"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.32827"},{"key":"e_1_2_6_10_1","unstructured":"Kanis J World Health Organization Center for Metabolic Bone Diseases. Assessment of Osteoporosis at the Primary Health\u2010Care Level. WHO Scientific Group Technical Report. WHO Collaborating Centre for Metabolic Bone Diseases University of Sheffield Medical School; 2007."},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1198-1"},{"key":"e_1_2_6_12_1","unstructured":"2015 ISCD Official Positions\u2014Adult.2015. Available at:https:\/\/www.iscd.org\/official-positions\/2015-iscd-official-positions-adult\/. Accessed March 14 2018."},{"key":"e_1_2_6_13_1","unstructured":"Bone density exam and testing: Understanding bone density test results Available athttps:\/\/www.nof.org\/patients\/diagnosis-information\/bone-density-examtesting\/Accessed March 8 2018"},{"key":"e_1_2_6_14_1","unstructured":"Research Electronic Data Capture(REDcap) [computer program] (2006\u20102013); Vanderbilt University."},{"key":"e_1_2_6_15_1","volume-title":"Daniels's and Worthington's Muscle Testing","author":"Hislop HH","year":"2014"},{"key":"e_1_2_6_16_1","unstructured":"Medical Research Council. Aids to the examination of the peripheral nervous system: Memorandum No. 45. 1970 Available athttps:\/\/www.mrc.ac.uk\/research\/facilities-and-resources-for-researchers\/mrc-scales\/mrc-muscle-scale\/Accessed March 15 2018"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.2269"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dhjo.2014.09.011"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.68.5.543"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)62217-4"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000485"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2010.01.008"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.4.755"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148218308621?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148218308621?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.pmrj.2018.08.387","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.pmrj.2018.08.387","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.pmrj.2018.08.387","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T23:37:14Z","timestamp":1694389034000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1016\/j.pmrj.2018.08.387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,25]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1016\/j.pmrj.2018.08.387"],"URL":"https:\/\/doi.org\/10.1016\/j.pmrj.2018.08.387","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,25]]},"assertion":[{"value":"2018-05-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}