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Occurrence of Clinical Bone Fracture Following a Prolonged Stay in Intensive Care Unit: A Retrospective Controlled Study

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Abstract

Clinical consequences of critical illness and critical care (CC) on bone health remain largely unexplored. This retrospective study aimed to assess the number of new bone fractures (BF) following a prolonged length of stay (LOS) in intensive care unit (ICU). Adults admitted in our tertiary ICU during 2013 with a stay >7 days were included (CC group). Patients who died in ICU or lost to follow-up were excluded. For each CC patient still alive after 2 years of follow-up, 2 control patients, scheduled for surgery during 2013, were recruited and matched for gender and age. Basal fracture risk before admission was calculated using FRAX tool. General practitioners were phoned to check out new bone fracture (BF) during 2 years after admission. Of the 457 enrolled CC patients, 207 did not meet inclusion criteria and 72 died during FU (median age 72 [65–77] years). New BF occurred in 9 of the 178 patients still alive at the end of FU (5%). Median age of these patients was 64 [53–73] years. Fractured patients did not differ from non-fractured ones based on demographic and clinical characteristics, excepting for FRAX risks that were higher in fractured patients. In the control group, 327 patients were analyzed. Their rate of BF was 3.4% without statistical significance compared to the CC group. FRAX risks were similar in both groups. The risk of new BF in CC group, expressed as an odds ratio, was 50% higher than in the control group without achieving statistical significance (odds ratio 1.53; 95% confidence interval 0.62–3.77; p = 0.35). When comparing ICU survivors to patients who underwent uncomplicated surgery in the present preliminary study included limited cohorts, the fracture risk in the 2 years following prolonged ICU stay was not statistically higher. However, CC fractured patients had higher FRAX risks than non-fractured patients. Such screening could help to target prevention and appropriate treatment strategies.

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Abbreviations

BF:

Bone fracture

BMD:

Bone mineral density

BMI:

Body mass index

CC:

Critical care

CVVH:

Continuous venovenous hemofiltration

FU:

Follow-up

ICU:

Intensive care unit

LOS:

Length of stay

PICS:

Post-intensive care syndrome

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Acknowledgements

We want to thank Laure Michel and Maxime Bawin, students at the University of Liège, for their valuable contribution in data recording.

Funding

The present study has not been supported by any funding.

Author contributions

AFR, EC, and OB designed research; AFR conducted research; AFR and OB analyzed data; AFR wrote paper; EC, PD, JYR, and OB critically reviewed paper. All authors approved the final manuscript.

Author information

Authors and Affiliations

  1. Burn Centre and General Intensive Care Department, University Hospital, University of Liège, Sart-Tilman B35, 4000, Liège, Belgium

    Anne-Françoise Rousseau & Pierre Damas

  2. Clinical Chemistry Department, University Hospital, University of Liège, Sart-Tilman, Liège, Belgium

    Etienne Cavalier

  3. Department of Public Health, Epidemiology and Health Economics, University of Liège, Sart-Tilman, Liège, Belgium

    Jean-Yves Reginster & Olivier Bruyère

Authors
  1. Anne-Françoise Rousseau
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  2. Etienne Cavalier
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  3. Jean-Yves Reginster
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  4. Pierre Damas
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  5. Olivier Bruyère
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Corresponding author

Correspondence to Anne-Françoise Rousseau.

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Conflict of interest

All authors declare that they have no competing interests.

Ethics Approval

The present study was approved by the local Ethics Committee of the University Hospital of Liège (Ref 2015/206).

Informed Consent

The local Ethics Committee of the University Hospital of Liège considered that an informed consent was not required, in view of the retrospective method of the study.

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Rousseau, AF., Cavalier, E., Reginster, JY. et al. Occurrence of Clinical Bone Fracture Following a Prolonged Stay in Intensive Care Unit: A Retrospective Controlled Study. Calcif Tissue Int 101, 465–472 (2017). https://doi.org/10.1007/s00223-017-0300-5

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  • DOI: https://doi.org/10.1007/s00223-017-0300-5

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