Bone Failure in Critical Illness. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Lee, Paul; Nair, Priya; Eisman, John A.; Center, Jacqueline R.
• Is Part Of: Critical care medicine. Volume 44:Issue 12(2016)
• Publication Date: 2016-12
• Subjects: bisphosphonate -- critically ill -- intensive care unit -- osteoporosis -- vitamin D; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000001874
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: 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. Data Sources, Data Selection, and Data Extraction: Search of the PubMed database and manual review of selected articles investigating bone pathophysiology in critical illness. Data Synthesis: 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.