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 1: Measurement of bone turnover markers. Details of BTMs measurement. (DOC 22 kb)13054_2017_1657_MOESM1_ESM.doc
Additional file 2: Study operating procedures. Details of study procedure and data collection time points from enrolment to completion. (DOCX 12 kb)13054_2017_1657_MOESM2_ESM.docx
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)13054_2017_1657_MOESM3_ESM.docx
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)13054_2017_1657_MOESM4_ESM.docx
Lown DJ, Knott J, Rechnitzer T, Maclsaac C. Predicting short-term and long-term mortality in elderly emergency patients admitted for intensive care. Crit Care Resusc. 2013;15(1):49–55. PubMed
Angus DC, Carlet J, 2002 Brussels Roundtable Participants. Surviving intensive care: a report from the 2002 Brussels Roundtable. 2003;29:368-377. doi: 10.1007/s00134-002-1624-8.
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis Prevention, Diagnosis, and Therapy. JAMA. 2001;285(6):785–95. doi: 10.1001/jama.285.6.785.
Amrein K, Fahrleitner-Pammer A, Dimai HP. Bone - a casualty of ICU survival? Crit Care. 2015:1-2. doi: 10.1186/s13054-015-0977-7.
Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J, Committee of Scientific Advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int. 2000;11 Suppl 6:S2–S17. CrossRefPubMed
Van den Berghe G, Baxter RC, Weekers F, et al. The combined administration of GH-releasing peptide-2 (GHRP-2), TRH and GnRH to men with prolonged critical illness evokes superior endocrine and metabolic effects compared to treatment with GHRP-2 alone. Clin Endocrinol (Oxf). 2002;56(5):655–69. CrossRef
Van den Berghe G, Weekers F, Baxter RC, et al. Five-day pulsatile gonadotropin-releasing hormone administration unveils combined hypothalamic-pituitary-gonadal defects underlying profound hypoandrogenism in men with prolonged critical illness. J Clin Endocrinol Metab. 2001;86(7):3217–26. PubMed
Van den Berghe G, Wouters P, Weekers F, et al. Reactivation of pituitary hormone release and metabolic improvement by infusion of growth hormone-releasing peptide and thyrotropin-releasing hormone in patients with protracted critical illness. J Clin Endocrinol Metab. 1999;84:1311–23. PubMed
- 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
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II