Abstract
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.
Highlights
Critical illness is associated with increased risk of fragility fracture and loss of bone mineral density (BMD), the impact of medication exposures and time remain unexplored
A greater loss of spine BMD was observed in the first year after critical illness, with anti-fracture therapy use associated with an increase in BMD compared to a decrease in BMD in those that did not receive such therapy
In men BMD loss increased in the second year after critical illness, and there was no association between use of anti-fracture therapy or glucocorticoids and change in BMD, only a small proportion of men received post-Intensive care unit (ICU) bonerelated medications
Summary
Critical illness is associated with increased risk of fragility fracture and loss of bone mineral density (BMD), the impact of medication exposures (bone anti-fracture therapy or glucocorticoids) and time remain unexplored. 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]. The annual change in femur and spine BMD in women that survived critical illness was -1.96% and -2.85%, compared to -0.65% and Orford et al Critical Care (2017) 21:69
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