Bone metabolism and fracture risk during and after critical illness

Rousseau, Anne-Françoise; Kerschan‐Schindl, Katharina; Scherkl, Mario; Amrein, Karin

doi:10.1097/mcc.0000000000000734

Cited by 20 publications

(20 citation statements)

References 88 publications

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“…From studies conducted so far, an evident association between critical illness and high bone resorption, leading to secondary osteopenia and osteoporosis, emerges. In addition to vitamin D deficit (especially in long-stayers), several other factors can have a role in bone loss, including immobilization, a lack of muscle activity, inflammation, neuroendocrine stress reaction, malnutrition, gut microbiota dysregulation, and drugs [1,65,66]. Loss of bone mass appears to persist for up to 2 years [27] and, despite gradual improvement in bone formation, bone mass density may not completely recover for several years following acute illness.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study on Critical Illness and Changes in Bone Turnover in Adult Patients

Marcucci¹,

Cozzolino²,

Duradoni³

et al. 2022

Preprint

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Critical illness has been recognized to acutely influence bone metabolism and, consequently, bone mineral density. The main purpose of this study was to describe bone metabolism changes in adult survivors of critical illness in the attempt to correlate changes with severity scores. It is an open, prospective, observational, monocentric study on patients admitted to the ICU was conducted, evaluating bone metabolism at baseline (within 72 hours of ICU admission), 6 months, and 12 months. Fifty-nine patients admitted to the ICU (63% males), mean age 58 ± 16 years, were enrolled. Of these, 20 patients (34%) completed the one-year follow up. At baseline, bone resorption showed an increase, which was maintained at 6 months, with normalization at 12 months. Patients showed, in a majority of cases, hypovitaminosis D with hyperparathyroidism at baseline with subsequent normalization. A trend towards a correlation was described between severity scores and serum 25(OH) vitamin D and bone turnover marker levels. These results contribute to the confirmation of a positive association between critical illness requiring ICU and bone metabolism changes. This study poses the bases for further studies to evaluate bone health in ICU patients.

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Section: Discussionmentioning

confidence: 99%

A Prospective Study on Critical Illness and Changes in Bone Turnover in Adult Patients

Marcucci¹,

Cozzolino²,

Duradoni³

et al. 2022

Preprint

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“…Immobilization is evidently the main factor contributing to changes in bone turnover in ICU patients. Facilitation of physical activity and early mobilization are recommended [21].…”

Section: Discussionmentioning

confidence: 99%

Denosumab for prevention of immobilization-induced alterations of bone turnover in patients admitted to a neurosurgical intensive care unit: a randomized controlled trial

Kerschan‐Schindl

Wadiura

Butylina

et al. 2022

Preprint

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Background: Metabolic bone disease is a devastating condition in critically ill patients admitted to an intensive care unit (ICU). We investigated the effects of the antiresorptive drug denosumab on bone metabolism in previously healthy patients. Methods: Fourteen patients with severe intracerebral or subarachnoid hemorrhage were included in a phase 2 trial. Within 72 hours after ICU admission, they were randomized in a 1:1 ratio to receive denosumab 60 mg or placebo subcutaneously. The primary endpoint was group differences in the percentage change of C-terminal telopeptide of type 1 collagen (CTX-1) levels in serum from denosumab/placebo application to four weeks thereafter. Changes in serum levels of bone formation markers and urinary calcium excretion were secondary outcome parameters. Results: Regarding serum levels of CTX-1, changes over time averaged -0.45 ng/ml (95%CI: -0.72, -0.18) for the denosumab group and +0.29 ng/ml (95%CI: -0.01, +0.58) for the placebo group. The primary endpoint, the group difference in changes between baseline and secondary measurement, adjusted for baseline serum levels and baseline neurological status, averaged -0.74 ng/ml (95%CI: -1.14, -0.34; p=0.002). The group difference in changes between baseline and secondary osteocalcin measurement averaged -5.60 ng/ml (95%CI: -11.2, -0.04; p=0.049). The group difference in averaged change between baseline and secondary measurement of 24-hour urine calcium excretion was significant (-1.77 mmol/l (95%CI: -3.48; -0.06; p=0.044). No adverse events could be attributed to the study medication. Conclusion: The investigation proved that a single application of denosumab early after admission to an ICU prevents any immobilization-associated increase in bone resorption among previously healthy individuals.

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“…Apart from relevant short-term endpoints, accumulating evidence suggests that particularly elderly ICU survivors are at high risk for osteoporosis leading to fractures and likely an increased risk of re-hospitalization [43].…”

Section: Where Are We Now?mentioning

confidence: 99%

Vitamin D in critical care: where are we now and what is next?

Amrein

Hoffmann

Lobmeyr

2021

Current Opinion in Critical Care

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Purpose of reviewTo summarize the recent evidence on the role of vitamin D deficiency in critically ill patients and emerging data claiming a role of vitamin D in COVID-19. Recent findingsVitamin D is a strong predictor for worse outcomes in critically ill patients, and as well in COVID-19. The vitamin D content in typical nutrition regimes is lower than what is recommended for the general population. Although its supplementation has been shown to reduce respiratory tract infections, asthma exacerbations and mortality risk in noncritically ill patients, its role in the acute setting is not yet clear. Several small intervention trials have shown interesting results in COVID-19, and larger studies are ongoing. SummaryAlthough research on this topic is still ongoing, it appears reasonable to recommend at least the standard vitamin dose for the healthy population (600-800 IU of native vitamin D3). Many questions remain on the actual role, the best metabolite, regime, and so forth. However, the role for vitamin D in bone health is clear. Elderly ICU survivors have a high risk for osteoporosis/fractures, so at least in this population, an optimal vitamin D status should be targeted.

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Bone metabolism and fracture risk during and after critical illness

Cited by 20 publications

References 88 publications

A Prospective Study on Critical Illness and Changes in Bone Turnover in Adult Patients

A Prospective Study on Critical Illness and Changes in Bone Turnover in Adult Patients

Denosumab for prevention of immobilization-induced alterations of bone turnover in patients admitted to a neurosurgical intensive care unit: a randomized controlled trial

Vitamin D in critical care: where are we now and what is next?

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