Dec 18, 2016
Show me an intensivist that cares about bone! I do.
Critical illness is detrimental to bone health for various reasons – profound vitamin D deficiency, extreme immobilisation, inflammation, excessive cytokine levels, malnutrition, endocrine dysfunction and medication all may lead to accelerated bone turnover and rapid bone loss.
Today, many ICU patients are elderly, and therefore at substantial fracture risk even before critical illness. As an example, one year after a hip fragility fracture, 50 % of patients are either dead or independent. Bone health is therefore very important for morbidity and mortality of ICU survivors, adding up to the long-term sequelae after severe illness. Generally, osteoporosis remains underdiagnosed and therefore undertreated.
On the other hand, recent evidence suggests that osteoporotic patients previously treated with a bisphosphonate may have a survival benefit compared to other patients.
Furthermore, several publications in the last years showed that FGF-23, a phosphaturic, bone-derived hormone predicts outcome in the acute setting very accurately.
Overall, the link between critical illness and bone is strong in both directions and will be discussed in this talk.