A year after being hospitalized in intensive care, patients have reduced bone density compared with the general population that marks an increased rate of bone loss and puts them at greater risk for fractures, according to research published in the American Journal of Respiratory and Critical Care Medicine.

Neil R. Orford, MBBS, director of the ICU at the University Hospital Geelong in Australia, and colleagues included 66 patients in the study (mean age of 68.8 years) who underwent bone mineral density (BMD) testing after leaving the ICU and again a year later. Study participants were also matched and compared with patients from the Geelong Osteoporosis Study, a large random population-based sample used to determine normal ranges of BMD over time.

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They found that patients who spent 24 hours or more on a breathing machine in an ICU had 1.59%  less bone mineral density (BMD) (95% CI -2.18, -1.01, p < 0.001) at the anterior-posterior spine, and had 1.2% less BMD (95% CI -1.69, -0.70, p < 0.001) at the femoral neck 1 year after being hospitalized. These bone losses in both the lower spine and thigh bones were statistically significant in the overall study population and in the women participants. In men, only the BMD decline in the thigh bones was significant.

The researchers also examined biochemical changes in the participants that might affect bone density: two molecular “bone turnover markers,” type 1 N-terminal procollagen, which helps bones form, and collagen type 1 cross-linked c-telopeptide, which helps bones break down. They observed increased bone resorption during critical illness that returned to normal bone resorption during the year after ICU treatment, but that left a bone-mass deficit.

“Our study demonstrates a need to investigate the role [of] anti-resorptive therapies to prevent bone loss in critically ill patients during their time in the hospital and afterwards during recovery,” said Dr Orford in a press release.