Changes in bone mineral density in the year after critical illness

Rationale: Critical illness may be associated with increased bone turnover and loss of bone mineral density ( BMD ). Prospective evidence describing long-term changes in BMD after critical illness is needed to further define this relationship. Objectives: To measure the change in BMD and bone turnover markers ( BTMs ) in subjects 1 year after critical illness compared with population-based control subjects. Methods: We studied adult patients admitted to a tertiary intensive care unit ( ICU ) who required mechanical ventilation for at least 24 hours. We measured clinical characteristics, BTMs, and BMD during admission and 1 year after ICU discharge. We compared change in BMD to age- and sex-matched control subjects from the Geelong Osteoporosis Study. Measurements and Main Results: Sixty-six patients completed BMD testing. BMD decreased significantly in the year after critical illness at both femoral neck and anterior–posterior spine sites. The annual decrease was significantly greater in the ICU cohort compared with matched control subjects ( anterior–posterior spine, −1.59%; 95% confidence interval, −2.18 to −1.01; P  <  0.001; femoral neck, −1.20%; 95% confidence interval, −1.69 to −0.70; P  <  0.001 ). There was a significant increase in 10-year fracture risk for major fractures ( 4.85 ± 5.25 vs. 5.50 ± 5.52; P  <  0.001 ) and hip fractures ( 1.57 ± 2.40 vs. 1.79 ± 2.69; P = 0.001 ). The pattern of bone resorption markers was consistent with accelerated bone turnover. Conclusions: Critically ill individuals experience a significantly greater decrease in BMD in the year after admission compared with population-based control subjects. Their bone turnover biomarker pattern is consistent with an increased rate of bone loss.