The online version of this article (doi:10.1186/s13054-017-1657-6) contains supplementary material, which is available to authorized users.
Critical 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.
In 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.
Ninety-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).
In 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.
Additional file 2: Study operating procedures. Details of study procedure and data collection time points from enrolment to completion. (DOCX 12 kb)
Additional file 3: Bone mineral density and T-score for the 2 years after critical illness in participants that completed all bone mineral density assessments. Bone mineral density and T-score at enrolment, 1 year, and 2 years after critical illness, presented overall and stratified by gender, for the 47 participants who completed all assessments. (DOCX 13 kb)
Additional file 4: Sensitivity analysis of annual BMD change in women and men. The sensitivity analysis of annual change in BMD compared to baseline for women and men who completed all three BMD assessments, with repeat measure analysis of variance to explore the relationship between anti-fracture use, glucocorticoid use, and time after ICU discharge. (DOCX 666 kb)
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- The association of time and medications with changes in bone mineral density in the 2 years after critical illness
Neil R. Orford
Julie A. Pasco
Sharon L. Brennan-Olsen
David J. Cooper
Mark A. Kotowicz
- BioMed Central
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