The association of time and medications with changes in bone mineral density in the 2 years after critical illness

Journal article


Orford, Neil R., Bailey, Michael, Bellomo, Rinaldo, Pasco, Julie A., Cattigan, Claire, Elderkin, Tania, Brennan-Olsen, Sharon L., Cooper, David J. and Kotowicz, Mark A.. (2017). The association of time and medications with changes in bone mineral density in the 2 years after critical illness. Critical Care. 21(1), pp. 1 - 10. https://doi.org/10.1186/s13054-017-1657-6
AuthorsOrford, Neil R., Bailey, Michael, Bellomo, Rinaldo, Pasco, Julie A., Cattigan, Claire, Elderkin, Tania, Brennan-Olsen, Sharon L., Cooper, David J. and Kotowicz, Mark A.
Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Keywordscritical illness; long-term outcomes; osteoporosis; fracture; bone loss; bone mineral density; bone turnover marker
Year2017
JournalCritical Care
Journal citation21 (1), pp. 1 - 10
PublisherBioMed Central
ISSN1364-8535
Digital Object Identifier (DOI)https://doi.org/10.1186/s13054-017-1657-6
Scopus EID2-s2.0-85016129716
Open accessOpen access
Page range1 - 10
Research GroupInstitute for Health and Ageing
Publisher's version
License
Place of publicationUnited Kingdom
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