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



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.



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).



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.
Barwon Health, Geelong, VIC, Australia. orfords@me.com.|Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia. orfords@me.com.|School of Medicine, Deakin University, Geelong, VIC, Australia. orfords@me.com.|Intensive Care Unit, University Hospital Geelong, Ryrie St, Geelong, VIC, 3220, Australia. orfords@me.com.
Neil R
NR
Orford
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia.
Michael
M
Bailey
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia.
Rinaldo
R
Bellomo
Barwon Health, Geelong, VIC, Australia.|School of Medicine, Deakin University, Geelong, VIC, Australia.|Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia.|Melbourne Medical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia.
Julie A
JA
Pasco
Barwon Health, Geelong, VIC, Australia.|School of Medicine, Deakin University, Geelong, VIC, Australia.
Claire
C
Cattigan
Barwon Health, Geelong, VIC, Australia.
Tania
T
Elderkin
School of Medicine, Deakin University, Geelong, VIC, Australia.|Melbourne Medical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia.|Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, VIC, Australia.|Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia.
Sharon L
SL
Brennan-Olsen
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia.
David J
DJ
Cooper
School of Medicine, Deakin University, Geelong, VIC, Australia.|Melbourne Medical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia.|Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, VIC, Australia.
Mark A
MA
Kotowicz
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D013131:Spine / Q000187:drug effects / Q000502:physiology; D013997:Time Factors
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids
Bone loss; Bone mineral density; Bone turnover marker; Critical illness; Fracture; Long-term outcomes; Osteoporosis