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Bone hyperresorption is prevalent in chronically critically ill patients

D M Nierman1, J I Mechanick

  • 1Department of Medicine, The Mount Sinai Medical Center, New York, NY 10029-6574, USA. dnierma@smtplink.mssm.edu

Chest
|October 29, 1998
PubMed
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Chronically critically ill patients show high rates of bone hyperresorption and abnormal parathyroid hormone (PTH) and vitamin D levels. These findings suggest a need for further investigation into screening and treatment strategies.

Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Bone Metabolism

Background:

  • Chronically critically ill (CCI) patients are survivors of life-threatening sepsis, often elderly, debilitated, and ventilator-dependent.
  • Understanding the prevalence of bone metabolic abnormalities in CCI patients is crucial for their management.

Purpose of the Study:

  • To determine the prevalence of bone hyperresorption.
  • To assess abnormalities in the parathyroid hormone (PTH)-vitamin D axis in CCI patients.

Main Methods:

  • A prevalence survey was conducted in a respiratory care step-down unit.
  • Forty-nine ventilator-dependent CCI patients were assessed.
  • Measurements included urine N-telopeptide (NTx) and serum intact PTH, 25-vitamin D, and 1,25-vitamin D levels.

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Main Results:

  • 92% of patients exhibited elevated urine NTx levels, indicating bone hyperresorption.
  • PTH levels varied: 42% had elevated PTH (vitamin D deficiency), 9% suppressed PTH (immobilization), and 49% normal PTH (overlap).
  • No significant differences in vitamin D metabolites were observed across PTH groups.

Conclusions:

  • CCI patients have a high prevalence of bone hyperresorption.
  • PTH levels can help elucidate the underlying causes of these bone metabolic changes.
  • Further research is needed to evaluate routine screening and the efficacy of vitamin D and antiresorptive therapies.