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Open Access 01-12-2017 | Research

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

Authors: Neil R. Orford, Michael Bailey, Rinaldo Bellomo, Julie A. Pasco, Claire Cattigan, Tania Elderkin, Sharon L. Brennan-Olsen, David J. Cooper, Mark A. Kotowicz

Published in: Critical Care | Issue 1/2017

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.

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Title: The association of time and medications with changes in bone mineral density in the 2 years after critical illness
Authors: Neil R. Orford
Michael Bailey
Rinaldo Bellomo
Julie A. Pasco
Claire Cattigan
Tania Elderkin
Sharon L. Brennan-Olsen
David J. Cooper
Mark A. Kotowicz
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-017-1657-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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