Bisphosphonates and metabolic bone disease in the ICU

作者：Hollander Jason M^*; Mechanick Jeffrey L

来源：Current Opinion in Clinical Nutrition and Metabolic Care, 2009, 12(2): 190-195.

DOI：10.1097/MCO.0b013e328321cda6

• bisphosphonate
• critical illness
• ICU
• metabolic bone disease
• osteoporosis

Purpose of review
The purpose of this review is to discuss the elements of critical illness that predispose to rapid and severe bone loss and illustrate how potent nitrogen containing intravenous bisphosphonates can mitigate this potentially serious disease.
Recent findings
Recent studies confirm that inflammatory cytokines, immobilization, and hormonal irregularities incite osteoclast-mediated bone resorption. Bisphosphonates are antiresorptive agents and well suited to treat this bone loss. Intravenous bisphosphonates have long been considered safe, but recent evidence has raised concerns in regard to such serious side effects as atrial fibrillation, osteonecrosis of the jaw, and 'frozen bone'.
Summary
Metabolic bone disease in the ICU is potentially a devastating consequence of critical illness. Screening with biochemical markers of bone turnover may allow identification of those most likely to have fracture after ICU discharge. Intravenous bisphosphonates are safe and very effective at preventing osteoporotic fracture in other populations. There is likely a subset of individuals who remain critically ill for a prolonged period of time that may benefit from an intravenous infusion of a potent aminobisphosphonate.

• 出版日期2009-3