Bone physiology and therapeutics in chronic critical illness

Modern medical practices allow patients to survive acute insults and be sustained by machinery and medicines for extended periods of time. We define chronic critical illness as a later stage of prolonged critical illness that requires tracheotomy. These patients have persistent elevations of inflamm...

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Bibliographic Details
Published in:Annals of the New York Academy of Sciences 2010-11, Vol.1211 (1), p.85-94
Main Authors: Via, Michael A., Gallagher, Emily Jane, Mechanick, Jeffrey I.
Format: Article
Language:English
Subjects:
allostasis
Animals
Bone and Bones - physiology
Bone Diseases, Metabolic - physiopathology
Bone Diseases, Metabolic - therapy
Bone Remodeling - physiology
bone resorption
Bone Resorption - physiopathology
Bone Resorption - therapy
chronic critical illness
Chronic Disease
Critical Illness
Humans
Illnesses
metabolic bone disease
Osteoporosis
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Summary:Modern medical practices allow patients to survive acute insults and be sustained by machinery and medicines for extended periods of time. We define chronic critical illness as a later stage of prolonged critical illness that requires tracheotomy. These patients have persistent elevations of inflammatory cytokines, diminished hypothalamic–pituitary function, hypercatabolism, immobilization, and malnutrition. The measurement of bone turnover markers reveals markedly enhanced osteoclastic bone resorption that is uncoupled from osteoblastic bone formation. We review the mechanisms by which these factors contribute to the metabolic bone disease of chronic critical illness and suggest potential therapeutics.
ISSN:0077-8923
1749-6632
DOI:10.1111/j.1749-6632.2010.05807.x