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Bone Failure in Critical Illness.

Paul Lee1, Priya Nair, John A Eisman

  • 11Department 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.

Critical Care Medicine
|June 30, 2016
PubMed
Summary
This summary is machine-generated.

Bone failure, characterized by excessive bone breakdown, may be an unrecognized cause of critical illness progression. This suggests bone-protective strategies could improve survival and reduce long-term complications for ICU patients.

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Area of Science:

  • Critical care medicine
  • Bone pathophysiology
  • Systemic inflammatory response

Background:

  • The origins of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are not fully understood.
  • These conditions are a major concern in intensive care units (ICUs).
  • This paper critically appraises bone failure as a potential unrecognized component of SIRS/MODS.

Purpose of the Study:

  • To investigate the role of bone failure in the development and progression of SIRS and MODS.
  • To determine if bone breakdown contributes to systemic inflammation and organ dysfunction.
  • To explore the potential of bone-protective strategies in critical illness.

Main Methods:

  • A comprehensive search of the PubMed database was conducted.
  • Manual review of selected articles focusing on bone pathophysiology in critical illness was performed.

Main Results:

  • Bone hyperresorption is common in critically ill patients.
  • Bone breakdown releases inflammatory cytokines and toxins, exacerbating hypercytokinaemia and metabolic toxaemia.
  • Use of anti-resorptive medication before admission is linked to better survival in critically ill patients.

Conclusions:

  • Hyperresorptive bone failure is proposed as an unrecognized, causal component of SIRS/MODS, driving critical illness progression.
  • Validating this hypothesis suggests bone-preserving strategies could decrease mortality in critical illness.
  • Such strategies may also reduce the risk of osteoporosis and fractures in ICU survivors.