Biochemical response to treatment of bone hyperresorption in chronically critically ill patients.
OBJECTIVE
The chronically critically ill (CCI) are a subgroup of critically ill patients who have survived an acute critical illness but remain profoundly debilitated and ventilator dependent. We have previously shown that CCI patients have a very high prevalence of bone hyperresorption. The objective of this present study was to determine the biochemical response of bone hyperresorption in CCI patients to treatment with either calcitriol alone or calcitriol and pamidronate.


METHODS
Retrospective survey.


METHODS
Respiratory care step-down unit (RCU) at a tertiary-care teaching hospital.


METHODS
Fifty-five ventilator-dependent CCI patients transferred from ICUs within the same institution who had elevated urine N-telopeptide (NTx) levels at RCU admission, who were treated with either calcitriol alone (n = 44) or calcitriol and pamidronate (n = 11), and who had urine NTx levels remeasured following treatment.


METHODS
None.


RESULTS
Patients treated with calcitriol alone had a significant reduction in serum parathyroid hormone (PTH; 93+/-145 pg/mL vs 40+/-28 pg/mL; p = 0.02) but not in urinary NTx (187+/-146 nmol bone collagen equivalents [BCE]/mmol creatinine [Cr] vs. 178+/-123 nmol BCE/mmol Cr, p = 0.59). In contrast, patients treated with both calcitriol and pamidronate had a significant decrease in urine NTx at follow-up (329+/-238 to 100+/-85 nmol BCE/mmol Cr; p<0.01) but not in serum PTH (36+/-29 to 53+/-51 pg/mL; p = 0.44).


CONCLUSIONS
The bone hyperresorption of CCI patients is PTH independent and biochemically responds to treatment with calcitriol and pamidronate but not calcitriol alone.
Nierman
D M
DM
Department of Medicine, Mount Sinai Medical Center, New York, NY 10029-6574, USA. David_Nierman@MountSinai.org
Mechanick
J I
JI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002117:Calcitriol / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood*; D002120:Calcium Channel Agonists / Q000627:therapeutic use; D002908:Chronic Disease; D003094:Collagen / Q000652:urine*; D024042:Collagen Type I; D003404:Creatinine / Q000652:urine; D016638:Critical Illness / Q000534:rehabilitation; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D000077268:Pamidronate; D010281:Parathyroid Hormone / Q000097:blood*; D010455:Peptides / Q000652:urine*; D012124:Respiratory Care Units; D012189:Retrospective Studies; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D002120:Calcium Channel Agonists; D024042:Collagen Type I; D004164:Diphosphonates; D010281:Parathyroid Hormone; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D003094:Collagen; D003404:Creatinine; D002117:Calcitriol; D000077268:Pamidronate; D002118:Calcium