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

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, vol. 21, pp. 1-10, doi: 10.1186/s13054-017-1657-6.

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Title The association of time and medications with changes in bone mineral density in the 2 years after critical illness
Author(s) Orford, Neil R
Bailey, Michael
Bellomo, Rinaldo
Pasco, Julie AORCID iD for Pasco, Julie A orcid.org/0000-0002-8968-4714
Cattigan, Claire
Elderkin, Tania
Brennan-Olsen, Sharon L
Cooper, David J
Kotowicz, Mark AORCID iD for Kotowicz, Mark A orcid.org/0000-0002-8094-1411
Journal name Critical care
Volume number 21
Article ID 69
Start page 1
End page 10
Total pages 10
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017
ISSN 1364-8535
1466-609X
Keyword(s) Bone loss
Bone mineral density
Bone turnover marker
Critical illness
Fracture
Long-term outcomes
Osteoporosis
Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
Quality of life
prolonged critical illness
Randomised clinical trial
Acute respiratory failure
Long-term mortality
Intensive-care
Fracture risk
Rehabilitation
Survivors
Sepsis
Summary 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.
Language eng
DOI 10.1186/s13054-017-1657-6
Field of Research 110399 Clinical Sciences not elsewhere classified
11 Medical And Health Sciences
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30093267

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.