Occurrence of Clinical Bone Fracture Following a Prolonged Stay in Intensive Care Unit: A Retrospective Controlled Study
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.
KeywordsCritical care Critical illness Bone fracture FRAX index Long term outcomes
Bone mineral density
Body mass index
Continuous venovenous hemofiltration
Intensive care unit
Length of stay
Post-intensive care syndrome
We want to thank Laure Michel and Maxime Bawin, students at the University of Liège, for their valuable contribution in data recording.
The present study has not been supported by any funding.
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.
Conflict of interest
All authors declare that they have no competing interests.
The present study was approved by the local Ethics Committee of the University Hospital of Liège (Ref 2015/206).
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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