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

Gavala, Alexandra; Makris, Konstantinos; Korompeli, Anna; Myrianthefs, Pavlos

doi:10.1155/2016/1951707

Cited by 15 publications

(10 citation statements)

References 20 publications

(42 reference statements)

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“…A previous prospective observational study conducted on 28 adult patients with prolonged critical illness also described BTM levels at 5 weeks, reporting high beta-CTx levels in 45% of subjects at admission, increasing to more than 80% of subjects week 1 and 2, and more than 50% of subjects at week 5. In contrast, P1NP (bone formation marker) concentrations were reduced in 55% of subjects at admission to ICU and 10% of subjects by week 5 [37].…”

Section: Discussionmentioning

confidence: 90%

“…Thirteen studies (case series or cohort studies) have been published that include short-term evaluations of BTMs as outcome in ICU patients [9,25,[27][28][29][30][31][32][33][34][35][36][37]. All studies that evaluated BTMs described an initial increase of markers of bone reabsorption, suggesting an increased osteoclastic activity in ICU patients [1,9,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. One study also measured osteoclast precursors and mature osteoclasts in serum and described a significant increase in osteoclast precursors in ICU patients compared to controls [40].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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: 90%

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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show abstract

“…No studies on predictive value of bone turnover status for hospital outcomes in orthogeriatric patients have been reported. Previous studies found in critically ill patients on admission significantly elevated bone resorption markers, including bCTX levels ( 129 - 133 ), and low-normal P1NP levels 132 , 133 . Lower BMD was shown to predict myocardial infarction in men and women during 5.7 years of follow-up 97 .…”

Section: Discussionmentioning

confidence: 90%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

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Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness.Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures.Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days.Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.

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“…Uncoupling of osteoclast and osteoblast regulation is known to occur in critical illness. Bone resorption starts immediately; CTX-1 values peak two weeks after baseline and return to initial values by four weeks [17].…”

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

Cited by 15 publications

References 20 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

Bone Turnover Status: Classification Model and Clinical Implications

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

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