A pilot study of change in fracture risk in patients with acute respiratory distress syndrome

Jaikitry Rawal, Mark J W McPhail, Gamumu Ratnayake, Pearl Chan, John Moxham, Stephen D R Harridge, Nicholas Hart, Hugh E Montgomery, Zudin A Puthucheary, Jaikitry Rawal, Mark J W McPhail, Gamumu Ratnayake, Pearl Chan, John Moxham, Stephen D R Harridge, Nicholas Hart, Hugh E Montgomery, Zudin A Puthucheary

Abstract

Introduction: Acute skeletal muscle wasting is a major contributor to post critical illness physical impairment. However, the bone response remains uncharacterized. We prospectively investigated the early changes in bone mineral density (BMD) and fracture risk in critical illness.

Methods: Patients were prospectively recruited ≤24 hours following intensive care unit (ICU) admission to a university teaching or a community hospital (August 2009 to April 2011). All were aged >18 years and expected to be intubated for >48 hours, spend >7 days in critical care and survive ICU admission. Forty-six patients were studied (55.3% male), with a mean age of 54.4 years (95% confidence interval (CI): 49.1 to 59.6) and an APACHE II score of 23.9 (95% CI: 22.4 to 25.5). Calcaneal dual X-ray absorptiometry (DXA) assessment of BMD was performed on day 1 and 10. Increase in fracture risk was calculated from the change in T-score.

Results: BMD did not change between day 1 and 10 in the cohort overall (0.434 (95% CI: 0.405 to 0.463) versus 0.425 g/cm(2) (95% CI: 0.399 to 0.450), P = 0.58). Multivariable logistical regression revealed admission corrected calcium (odds ratio (OR): 1.980 (95% CI: 1.089 to 3.609), P = 0.026) and admission PaO2-to-FiO2 ratio (OR: 0.916 (95% CI: 0.833 to 0.998), P = 0.044) to be associated with >2% loss of BMD. Patients with acute respiratory distress syndrome had a greater loss in BMD than those without (-2.81% (95% CI: -5.73 to 0.118%), n = 34 versus 2.40% (95% CI: 0.204 to 4.586%), n = 12, P = 0.029). In the 34 patients with acute respiratory distress syndrome, fracture risk increased by 19.4% (95% CI: 13.9 to 25.0%).

Conclusions: Patients with acute respiratory distress syndrome demonstrated early and rapid bone demineralisation with associated increase in fracture risk.

Figures

Figure 1
Figure 1
Change in T-score and percentage increase in fracture risk in patients with (n = 34) and without (n = 12) acute respiratory distress syndrome. FiO2 = Fraction of inspired oxygen, PaO2 = Partial pressure of oxygen in blood. Mann-Whitney U test was performed between groups, *P <0.05.

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