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Bone Failure in Critical Illness

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.

Type Journal
ISBN 1530-0293 (Electronic) 0090-3493 (Linking)
Authors Lee, P.; Nair, P.; Eisman, J. A.; Center, J. R.;
Responsible Garvan Author
Publisher Name CRITICAL CARE MEDICINE
Published Date 2016-01-01 00:00:00
Published Volume 44
Published Issue 12
Published Pages 2270-2274
Status Published in-print
URL link to publisher's version http://www.ncbi.nlm.nih.gov/pubmed/27355524
OpenAccess link to author's accepted manuscript version https://publications.gimr.garvan.org.au/open-access/13905