title: Bone Failure in Critical Illness.
abstract: OBJECTIVE
  The origin of systemic inflammatory response syndrome and multiple organ dysfunction syndrome is poorly understood but remains a fundamental concern in the ICU. This paper provides a critical appraisal on whether bone failure may represent an unrecognized component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome.
  Search of the PubMed database and manual review of selected articles investigating bone pathophysiology in critical illness.
  
  
  RESULTS
  Bone hyperresorption is highly prevalent among critically ill patients. Bone breakdown releases numerous systemically active cytokines and bone-sequestered toxins, with the capacity to fuel inflammatory hypercytokinaemia and metabolic toxaemia. Anti-resorptive medication inhibits bone break down and preadmission anti-resorptive use is associated with superior survival among critically ill patients.
  
  
  CONCLUSIONS
  We propose that hyperresorptive bone failure is an unrecognised component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome that is causal to critical illness progression. If this hypothesis is valid, bone preservative strategies could reduce the risk of osteoporosis/fractures among ICU survivors, as well as decreasing critical illness mortality.
authors.affiliation: 1Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.2Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst NSW, Australia.3Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.4School of Medicine, University of Notre Dame, Sydney, NSW, Australia.5Intensive Care Unit, St Vincent's Hospital, Sydney, NSW, Australia.6Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst NSW, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Lee
authors.forename: Priya
authors.initials: P
authors.lastname: Nair
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Center
mesh_terms: D001862:Bone Resorption / Q000150:complications* / Q000503:physiopathology; D016638:Critical Illness; D006801:Humans; D009102:Multiple Organ Failure / Q000150:complications* / Q000503:physiopathology; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000503:physiopathology