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1 From the Department of Medicine, The Mount Sinai Medical Center, New York, NY.
David M. Nierman, MD, FCCP, The Mount Sinai Medical Center—Box 1232, One Gustave L. Levy Place, New York, NY 10029-6574 email: dnierma{at}smtplink.mssm.edu
Study objective: Chronically critically ill (CCI) patients are primarily elderly people who have survived a life-threatening episode of sepsis but remain profoundly debilitated and ventilator dependent. The objective of this study was to determine the prevalence of bone hyperresorption and parathyroid hormone (PTH)-vitamin D axis abnormalities in these patients.
Design: Prevalence survey.
Setting: Respiratory care step-down unit (RCU) at a tertiary care teaching hospital.
Patients: Forty-nine ventilator-dependent CCI patients transferred from ICUs within the same institution.
Intervention: None.
Measurements and results: N-telopeptide (NTx) levels in 24-h urine collections and serum intact PTH, 25-vitamin D, and 1,25-vitamin D levels were measured within 48 h of RCU admission. Patients were hospitalized a median of 30 days before RCU admission. Four patients (9%) had normal NTx and PTH levels. Forty-five patients (92%) had elevated urine NTx levels consistent with bone hyperresorption. Nineteen patients (42% of total patients) had elevated PTH levels consistent with predominant vitamin D deficiency, 4 patients (9%) had suppressed PTH levels consistent with predominant hyperresorption from immobilization, and 22 patients (49%) had normal PTH levels consistent with an overlap of both vitamin D deficiency and immobilization. There were no differences in vitamin D metabolites among these groups.
Conclusions: CCI patients have a high prevalence of bone hyperresorption in which PTH levels may clarify the cause. Further studies will determine the efficacy and cost-effectiveness of routine NTx and PTH screening in these patients and the role of vitamin D and antiresorptive therapies.
Key Words: bedrest/adverse effects • bone diseases • metabolic/diagnosis • chronic disease • critical illness/rehabilitation • parathyroid hormones/blood • prevalence • risk factors • ventilator weaning • vitamin D/blood • vitamin D deficiency/epidemiology
Submitted on December 30, 1997
Accepted on April 9, 1998
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