Skeletal morbidity among survivors of critical illness*

Orford, Neil; Saunders, Kym; Merriman, E. N.; Henry, Margaret J.; Pasco, Julie A.; Stow, Peter; Kotowicz, Mark A.

doi:10.1097/ccm.0b013e318211ff3d

Cited by 39 publications

(40 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent retrospective cohort study of patients requiring intensive care and mechanical ventilation Ն 48 hours showed an increased risk for sustaining an osteoporosis-related fracture in postmenopausal female study patients, compared to population-based controls (hazard ratio 1.65, 95% CI 1.08 -2.52, P ϭ .02). 149 This latest clinical outcome finding supports our longstanding MSH-RCU aggressive approach to concurrent bone health management in CCI patients.…”

Section: Bone and Mineral Metabolismsupporting

confidence: 58%

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Schulman

Mechanick²

2012

Respir Care

View full text Add to dashboard Cite

Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic interventions are extrapolated from clinical critical care research, scientific theory, and years of CCI patient care experience. Intensive metabolic support (IMS) is a multi-targeted approach consisting of tight glycemic control with intensive insulin therapy, early and adequate nutrition therapy, nutritional pharmacology, management of metabolic bone disease, and meticulous attention to other endocrine/metabolic derangements. Ideally, IMS should be under the supervision of a metabolic support consultative team. Further research specifically focused on the CCI population is needed to validate this current approach.

show abstract

Section: Bone and Mineral Metabolismsupporting

confidence: 58%

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Schulman

Mechanick²

2012

Respir Care

View full text Add to dashboard Cite

show abstract

“…In recent years, an association between critical illness and accelerated bone turnover has been described, including an increase in bone turnover markers (BTM) during critical illness [18], accelerated loss of bone mineral density (BMD) in the year following critical illness [19], and increased fragility fractures in survivors of critical illness [20]. This association was, as expected, most pronounced in older women [19, 20].…”

Section: Introductionmentioning

confidence: 88%

The association of time and medications with changes in bone mineral density in the 2 years after critical illness

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundCritical illness is associated with increased risk of fragility fracture and loss of bone mineral density (BMD), although the impact of medication exposures (bone anti-fracture therapy or glucocorticoids) and time remain unexplored. The objective of this study was to describe the association of time after ICU admission, and post-ICU administration of bone anti-fracture therapy or glucocorticoids after critical illness, with change in BMD.MethodsIn this prospective observational study, conducted in a tertiary hospital ICU, we studied adult patients requiring mechanical ventilation for at least 24 hours and measured BMD annually for 2 years after ICU discharge. We performed mixed linear modelling to describe the association of time, and post-ICU administration of anti-fracture therapy or glucocorticoids, with annualised change in BMD.ResultsNinety-two participants with a mean age of 63 (±15) years had at least one BMD assessment after ICU discharge. In women, a greater loss of spine BMD occurred in the first year after critical illness (year 1: -1.1 ± 2.0% vs year 2: 3.0 ± 1.7%, p = 0.02), and anti-fracture therapy use was associated with reduced loss of BMD (femur 3.1 ± 2.4% vs -2.8 ± 1.7%, p = 0.04, spine 5.1 ± 2.5% vs -3.2 ± 1.8%, p = 0.01). In men anti-fracture and glucocorticoid use were not associated with change in BMD, and a greater decrease in BMD occurred in the second year after critical illness (year 1: -0.9 ± 2.1% vs year 2: -2.5 ± 2.1%, p = 0.03).ConclusionsIn women a greater loss of spine BMD was observed in the first year after critical illness, and anti-fracture therapy use was associated with an increase in BMD. In men BMD loss increased in the second year after critical illness. Anti-fracture therapy may be an effective intervention to prevent bone loss in women after critical illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1657-6) contains supplementary material, which is available to authorized users.

show abstract

“…A recent retrospective case-cohort study revealed a significant increase in fracture risk in survivors of critical illness, implying a clinically relevant impact of the reported alterations in bone biomarkers [6]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Bone Metabolism in Critically Ill Patients Using CTx and PINP

Gavala

Makris

Korompeli

et al. 2016

BioMed Research International

View full text Add to dashboard Cite

Background. Prolonged immobilization, nutritional and vitamin D deficiency, and specific drug administration may lead to significant bone resorption. Methods and Patients. We prospectively evaluated critically ill patients admitted to the ICU for at least 10 days. Demographics, APACHE II, SOFA scores, length of stay (LOS), and drug administration were recorded. Blood collections were performed at baseline and on a weekly basis for five consecutive weeks. Serum levels of PINP, β-CTx, iPTH, and 25(OH)vitamin D were measured at each time-point. Results. We enrolled 28 patients of mean age 67.4 ± 2.3 years, mean APACHE II 22.2 ± 0.9, SOFA 10.1 ± 0.6, and LOS 31.6 ± 5.7 days. Nineteen patients were receiving low molecular weight heparin, 17 nor-epinephrine and low dose hydrocortisone, 18 transfusions, and 3 phenytoin. 25(OH)vitamin D serum levels were very low in all patients at all time-points; iPTH serum levels were increased at baseline tending to normalize on 5th week; β-CTx serum levels were significantly increased compared to baseline on 2nd week (peak values), whereas PINP levels were increased significantly after the 4th week. Conclusions. Our data show that critically ill patients had a pattern of hypovitaminosis D, increased iPTH, hypocalcaemia, and BTMs compatible with altered bone metabolism.

show abstract

Skeletal morbidity among survivors of critical illness*

Cited by 39 publications

References 37 publications

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

The association of time and medications with changes in bone mineral density in the 2 years after critical illness

Evaluation of Bone Metabolism in Critically Ill Patients Using CTx and PINP

Contact Info

Product

Resources

About