Anti-fracture Therapy Effectively Prevents Bone Loss in Women Post-Critical Illness

Critical illness was found to be associated with sustained decreases in bone mineral density.
Critical illness was found to be associated with sustained decreases in bone mineral density.

Anti-fracture therapy was found to be an effective intervention to prevent bone mineral density (BMD) loss in women recovering from a critical illness, according to a study published in Critical Care.1

Neil Orford, MD, intensive care unit medical director at Barwon Health in Geelong, Australia and colleagues led a prospective observational cohort study to examine the association between post-intensive care unit (ICU) administration of anti-fracture therapy or glucocorticoids and longitudinal changes in BMD over a 2-year period. BMD was measured using dual-energy X-ray absorptiometry (DXA) at the proximal femur and lumbar spine. 

A total of 92 patients who met study inclusion criteria including duration of mechanical ventilation >24 hours were enrolled in the study during their tertiary, mixed medical, surgical, or cardiac surgical ICU stay.

Patient data were collected at ICU baseline, post-ICU discharge, 1-year post-ICU discharge, and 2-year post-ICU discharge. Of the 92 patients, 66 had 2 BMD assessments and 48 patients had all 3 BMD assessments.

Over the 2-year period following ICU hospitalization, 10 patients (6 women, 4 men) were prescribed anti-fracture therapies including alendronate (5 patients), denosumab (2 patients), strontium ranelate (2 patients), and risedronate (1 patient).

In 53 measurements from 43 women of annual change in BMD over the 2-year period there was a significant decrease in BMD observed in year 1 vs year 2 for spine BMD (-1.1±2.0 vs 3.0±1.7%, P =.02) but not in femur BMD (−0.3±1.9% vs 0.6±1.7%, P =.6).

There was also a significant difference in women who did and did not receive anti-fracture therapy for the femur (3.1±2.4% vs −2.8±1.7%, P =.04) and the spine (5.1±2.5% vs −3.2±1.8%, P =.01).

However, use and disuse of glucocorticoids in women was not associated with a difference in an annual change in BMD of the femur (−0.2±2.7% vs 0.5±1.6%, P =.8) or the spine (0.5±2.9% vs 1.4±1.6%, P =.8), respectively.

In women who did not receive anti-fracture therapy or glucocorticords there was a decrease in femur BMD from year 1 to 2 (−2.8±1.3% vs −1.9±0.7, P =.6,) and spine BMD from year 1 to 2 (−4.8±1.4% vs −1.3±1.8%, P =.08).

In the 48 male patients with 61 measurements of annual change in BMD over the 2-year period, there was a greater decrease in femur BMD at year 2 compared with year 1 (−0.9±2.1% vs −2.5±2.1%, P =.030), respectively.

There was no difference in the annual change in spine BMD in men from year 1 to year 2 (0.9±4.0% vs 2.1±4.0%, P =.45), respectively.

In men, there was no association between anti-fracture therapy use and disuse and annual change of BMD in the femur (−0.4±2.5% vs −3.0±2.0%, P =.1) or the spine (2.4±4.8% vs 0.7±3.6%, P =.6), respectively. Since only one male participant received glucocorticoids, the researchers did not perform analysis in this field.

In men not receiving anti-fracture therapy or glucocorticords, the annual decrease in femur BMD was significantly greater in year 2 than year 1 (−1.9±0.7% vs −3.2±0.7%, P =.03). There was no difference in annual change in spine BMD between year 1 and year 2 (0.0±1.2% vs 0.9±1.5%, P =.6).

“This implies that anti-resorptive therapy may be an effective intervention to prevent bone loss in women with critical illness as has been shown in other at-risk patients,” the researchers concluded.


Limitations and Disclosures

  • A relatively large percentage of patients were lost to follow-up within the 2-year period evaluated 

Reference

Orford NR, Bailey M, Bellomo R, et al. The association of time and medications with changes in bone mineral density in the 2 years after critical illness [published online March 21, 2017]. Crit Care. doi:10.1186/s13054-017-1657-6

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