Abstract
Background/Objectives: Bone mineral density (BMD) assessments are uncommon in people with chronic stroke, and the relationship between BMD and gait speed remains poorly understood. This study examined between-limb differences in BMD of individuals with chronic stroke and limited versus non-limited community ambulation and analyzed the relationship between BMD and gait speed. Methods: This cross-sectional study included people with chronic stroke divided into two groups by walking speed (slow group [SG], <0.8 m/s, n = 38, and fast group [FG], ≥0.8 m/s, n = 46) and age- and sex-matched healthy individuals (control group [CG], n = 35). All participants underwent calcaneal ultrasound densitometry. Results: All the BMD parameters differed significantly between limbs in the SG, with the affected side demonstrating inferior outcomes. The FG only exhibited a significant difference in the broadband ultrasonic attenuation, with lower values on the affected side. Among groups, the SG demonstrated lower values in the affected leg for all parameters compared with the corresponding limb of both the FG and the CG. Furthermore, the SG demonstrated reduced speed of sound (SOS) in the non-affected limb compared with the FG's in theirs. Multiple regression analysis revealed that the ambulation ability, the affected gastrocnemius spasticity, disability, and SOS of the affected limb together explained 71.9% of the gait speed variance. Conclusions: Among stroke survivors, a slower gait speed is associated with greater between-limb differences in BMD. SOS in the affected limb emerged as a key predictor of gait speed. This highlights the need for more thorough BMD evaluations for stroke patients.