Bisphosphonates and metabolic bone disease in the ICU.
OBJECTIVE
The purpose of this review is to discuss the elements of critical illness that predispose to rapid and severe bone loss and illustrate how potent nitrogen containing intravenous bisphosphonates can mitigate this potentially serious disease.


RESULTS
Recent studies confirm that inflammatory cytokines, immobilization, and hormonal irregularities incite osteoclast-mediated bone resorption. Bisphosphonates are antiresorptive agents and well suited to treat this bone loss. Intravenous bisphosphonates have long been considered safe, but recent evidence has raised concerns in regard to such serious side effects as atrial fibrillation, osteonecrosis of the jaw, and 'frozen bone'.


CONCLUSIONS
Metabolic bone disease in the ICU is potentially a devastating consequence of critical illness. Screening with biochemical markers of bone turnover may allow identification of those most likely to have fracture after ICU discharge. Intravenous bisphosphonates are safe and very effective at preventing osteoporotic fracture in other populations. There is likely a subset of individuals who remain critically ill for a prolonged period of time that may benefit from an intravenous infusion of a potent aminobisphosphonate.
Hollander
Jason M
JM
Princeton Endocrinology, Princeton, New Jersey, USA. drhollander@princetonendocrinology.com
Mechanick
Jeffrey I
JI
D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000503:physiopathology; D001862:Bone Resorption / Q000188:drug therapy* / Q000503:physiopathology; D016638:Critical Illness / Q000628:therapy*; D004164:Diphosphonates / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units
D050071:Bone Density Conservation Agents; D004164:Diphosphonates