Calcified Tissue International

, Volume 101, Issue 5, pp 465–472 | Cite as

Occurrence of Clinical Bone Fracture Following a Prolonged Stay in Intensive Care Unit: A Retrospective Controlled Study

  • Anne-Françoise Rousseau
  • Etienne Cavalier
  • Jean-Yves Reginster
  • Pierre Damas
  • Olivier Bruyère
Original Research


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.


Critical care Critical illness Bone fracture FRAX index Long term outcomes 



Bone fracture


Bone mineral density


Body mass index


Critical care


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.

Author contributions

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.

Ethics Approval

The present study was approved by the local Ethics Committee of the University Hospital of Liège (Ref 2015/206).

Informed Consent

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.


  1. 1.
    Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, Brady SL, Brodsky MB, Denehy L, Elliott D, Flatley C, Harabin AL, Jones C, Louis D, Meltzer W, Muldoon SR, Palmer JB, Perme C, Robinson M, Schmidt DM, Scruth E, Spill GR, Storey CP, Render M, Votto J, Harvey MA (2012) Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 40:502–509CrossRefPubMedGoogle Scholar
  2. 2.
    Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM, Canadian Critical Care Trials G (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304CrossRefPubMedGoogle Scholar
  3. 3.
    Orford N, Cattigan C, Brennan SL, Kotowicz M, Pasco J, Cooper DJ (2014) The association between critical illness and changes in bone turnover in adults: a systematic review. Osteoporos Int 25:2335–2346CrossRefPubMedGoogle Scholar
  4. 4.
    Cavalier E, Bergmann P, Bruyere O, Delanaye P, Durnez A, Devogelaer JP, Ferrari SL, Gielen E, Goemaere S, Kaufman JM, Toukap AN, Reginster JY, Rousseau AF, Rozenberg S, Scheen AJ, Body JJ (2016) The role of biochemical of bone turnover markers in osteoporosis and metabolic bone disease: a consensus paper of the Belgian Bone Club. Osteoporos Int 27:2181–2195CrossRefPubMedGoogle Scholar
  5. 5.
    Rousseau AF, Damas P, Janssens M, Kalin S, Ledoux D, Le Goff C, Gadisseur R, Delanaye P, Cavalier E (2014) Critical care and vitamin D status assessment: what about immunoassays and calculated free 25OH-D? Clin Chim Acta 437:43–47CrossRefPubMedGoogle Scholar
  6. 6.
    Orford NR, Lane SE, Bailey M, Pasco JA, Cattigan C, Elderkin T, Brennan-Olsen SL, Bellomo R, Cooper DJ, Kotowicz MA (2016) Changes in bone mineral density in the year after critical illness. Am J Respir Crit Care Med 193:736–744CrossRefPubMedGoogle Scholar
  7. 7.
    Rawal J, McPhail MJ, Ratnayake G, Chan P, Moxham J, Harridge SD, Hart N, Montgomery HE, Puthucheary ZA (2015) A pilot study of change in fracture risk in patients with acute respiratory distress syndrome. Crit Care 19:165CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Amrein K, Fahrleitner-Pammer A, Dimai HP (2015) Bone—a casualty of ICU survival? Crit Care 19:253CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Orford NR, Saunders K, Merriman E, Henry M, Pasco J, Stow P, Kotowicz M (2011) Skeletal morbidity among survivors of critical illness. Crit Care Med 39:1295–1300CrossRefPubMedGoogle Scholar
  10. 10.
    Johansson H, Kanis JA, McCloskey EV, Oden A, Devogelaer JP, Kaufman JM, Neuprez A, Hiligsmann M, Bruyere O, Reginster JY (2011) A FRAX(R) model for the assessment of fracture probability in Belgium. Osteoporos Int 22:453–461CrossRefPubMedGoogle Scholar
  11. 11.
    Neuprez A, Johansson H, Kanis JA, McCloskey EV, Oden A, Bruyere O, Hiligsmann M, Devogelaer JP, Kaufman JM, Reginster JY (2009) A FRAX model for the assessment of fracture probability in Belgium. Rev Med Liege 64:612–619PubMedGoogle Scholar
  12. 12.
    Griffiths RD, Hall JB (2010) Intensive care unit-acquired weakness. Crit Care Med 38:779–787CrossRefPubMedGoogle Scholar
  13. 13.
    Patman SM, Dennis D, Hill K (2011) The incidence of falls in intensive care survivors. Aust. Crit. Care 24:167–174CrossRefPubMedGoogle Scholar
  14. 14.
    Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, Himmelfarb CR, Desai SV, Ciesla N, Herridge MS, Pronovost PJ, Needham DM (2014) Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med 42:849–859CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F, van Schaik IN, Schultz MJ, Horn J, van der Schaaf M (2015) Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study. Crit Care 19:196CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lee P (2011) Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 25:769–781CrossRefPubMedGoogle Scholar
  17. 17.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930CrossRefPubMedGoogle Scholar
  18. 18.
    Amrein K, Schnedl C, Holl A, Riedl R, Christopher KB, Pachler C, Urbanic Purkart T, Waltensdorfer A, Munch A, Warnkross H, Stojakovic T, Bisping E, Toller W, Smolle KH, Berghold A, Pieber TR, Dobnig H (2014) Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA 312:1520–1530CrossRefPubMedGoogle Scholar
  19. 19.
    Heaney RP, Holick MF (2011) Why the IOM recommendations for vitamin D are deficient. J Bone Miner Res 26:455–457CrossRefPubMedGoogle Scholar
  20. 20.
    Via MA, Potenza MV, Hollander J, Liu X, Peng Y, Li J, Sun L, Zaidi M, Mechanick JI (2012) Intravenous ibandronate acutely reduces bone hyperresorption in chronic critical illness. J Intensive Care Med. 27:312–318CrossRefPubMedGoogle Scholar
  21. 21.
    Lee P, Ng C, Slattery A, Nair P, Eisman JA, Center JR (2016) Preadmission bisphosphonate and mortality in critically ill patients. J Clin Endocrinol Metab 101:1945–1953CrossRefPubMedGoogle Scholar
  22. 22.
    Schulman RC, Moshier EL, Rho L, Casey MF, Godbold JH, Zaidi M, Mechanick JI (2016) Intravenous pamidronate is associated with reduced mortality in patients with chronic critical illness. Endocr Pract 22:799–808CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Anne-Françoise Rousseau
    • 1
  • Etienne Cavalier
    • 2
  • Jean-Yves Reginster
    • 3
  • Pierre Damas
    • 1
  • Olivier Bruyère
    • 3
  1. 1.Burn Centre and General Intensive Care Department, University HospitalUniversity of LiègeLiègeBelgium
  2. 2.Clinical Chemistry Department, University HospitalUniversity of LiègeLiègeBelgium
  3. 3.Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium

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