Changes in Bone Mineral Density in the Year after Critical Illness

Orford, Neil; Lane, Stephen; Bailey, Michael; Pasco, Julie A.; Cattigan, Claire; Elderkin, Tania; Brennan-Olsen, Sharon L.; Bellomo, Rinaldo; Cooper, Jamie; Kotowicz, Mark A.

doi:10.1164/rccm.201508-1514oc

Cited by 49 publications

(74 citation statements)

References 73 publications

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“…A very recent study found increased CTx and decreased serum PINP levels during ICU stay which is in accordance with our findings [9]. In addition to this study we found a commensurate response in bone formation markers during critical illness, that is, after the 3rd week of ICU stay as stated above.…”

Section: Discussionsupporting

confidence: 93%

“…In accordance with our study patients had during their ICU stay insufficient vitamin D serum levels, increased iPTH serum levels, and hypocalcaemia [9]. It was also suggested that vitamin D deficiency in critically ill patients with resultant secondary hyperparathyroidism along with prolonged immobilization and other metabolic abnormalities may increase the risk of excessive bone resorption [1, 17].…”

Section: Discussionsupporting

confidence: 85%

“…Serum PINP is the reference standard for bone formation, because most PINP probably is produced during bone formation, the assay is widely available as an automated immunoassay or manual radioimmunoassay, and the biological and analytical variability is well known [7]. These two markers have been studied extensively in patients with osteoporosis but were only occasionally evaluated in critically ill patients and especially β -CTx in only two studies and PINP in another [4, 8, 9]. Therefore more data are needed to establish their validity in this heterogeneous group of patients.…”

Section: Introductionmentioning

confidence: 99%

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

Gavala

Makris

Korompeli

et al. 2016

BioMed Research International

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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

Gavala

Makris

Korompeli

et al. 2016

BioMed Research International

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“…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: 87%

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

et al. 2017

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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.

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“…Patients recovered from critical illness have been demonstrated to have decreased bone mineral density (BMD) [1]. The global awareness of long term consequences of critical illness is rapidly increasing, but the identification of specific pathophysiological mechanisms is still tentative.…”

Section: Introductionmentioning

confidence: 99%