Osteoporosis International

, Volume 25, Issue 10, pp 2335–2346 | Cite as

The association between critical illness and changes in bone turnover in adults: a systematic review

  • N. Orford
  • C. Cattigan
  • S. L. Brennan
  • M. Kotowicz
  • J. Pasco
  • D. J. Cooper



Critical illness may lead to altered bone turnover and associated adverse health outcomes. This systematic review found moderate evidence for a positive association between critical illness and increased bone turnover. Prospective cohort studies that identify the extent and risk factors for critical illness related bone loss are required.


Intensive care patients face health issues that extend beyond their critical illness and result in significant morbidity and mortality. Critical illness may result in altered bone turnover due to associated immobilisation, inflammation, exposure to medications that effect bone and calcium metabolism, and endocrine dysfunction. The aim of this study was to synthesise the existing evidence for altered bone turnover in adults admitted to intensive care.


A literature search using MEDLINE and EMBASE was performed from 1965 to March 2013. Reviewed studies investigated the relationship between critical illness and evidence of altered bone turnover (bone turnover markers, bone mineral density, or fracture). Studies were rated upon their methodological quality, and a best-evidence synthesis was used to summarise the results.


Four cohort and seven case–control studies were identified for inclusion, of which five studies were rated as being of higher methodological quality. Ten of the studies measured bone turnover markers, and one study fracture rate. Findings were consistent across studies, and best-evidence analysis resulted in a conclusion that moderate evidence exists for an association between critical illness requiring admission to intensive care and altered bone turnover.


A positive association between critical illness requiring intensive care admission and bone turnover exists, although data are limited, and the risk factors and the nature of the relationship are not yet understood. Prospective cohort studies that identify risk factors and extent of critical illness related bone turnover changes are required.


Bone turnover Critical care Intensive care Mechanical ventilation Osteoporosis 



SLB is supported by the NHMRC Early Career Fellowship (1012472).

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • N. Orford
    • 1
    • 2
  • C. Cattigan
    • 2
  • S. L. Brennan
    • 3
    • 4
  • M. Kotowicz
    • 2
    • 5
  • J. Pasco
    • 6
  • D. J. Cooper
    • 1
  1. 1.Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.School of MedicineDeakin UniversityMelbourneAustralia
  3. 3.NorthWest Academic Centre, Department of MedicineThe University of MelbourneMelbourneAustralia
  4. 4.Australian Institute for Musculoskeletal Science (AIMSS) and Epidemiology Unit for Healthy Ageing, School of MedicineDeakin UniversityMelbourneAustralia
  5. 5.Department Medicine, Barwon Health, NorthWest Academic CentreThe University of MelbourneMelbourneAustralia
  6. 6.Epidemiology Unit for Healthy Ageing, School of MedicineDeakin UniversityMelbourneAustralia

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