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Acute-care nurses should pay special attention to the potential for serious bone loss and increased risk of osteoporosis in ICU patients with prolonged lengths of stay, according to a new study that confirms long-held beliefs. Most of these patients are elderly and chronically ill, and many are admitted to ICUs and CCUs following cardiac and other major invasive surgeries.
Staff nurses need to be vigilant in identifying high-risk patients and provide them with nutritional and IV-drip support, if necessary, to help prevent bone hyper-resorption, according to David M. Nierman, MD, director of the medical ICU at Mount Sinai Medical Center in New York and study’s lead investigator.
The IV-drip is the best source of the needed nutrient vitamin D because it comes in a molecularly active form that is easily and rapidly processed by the body, Nierman says. Not all drips contain vitamin D. When deemed appropriate, nurses should consider therapies that block bone loss, including the use of individualized dosages of panidronate, a commonly used osteoporosis drug.
Early prevention is important because these measures can effectively decrease the likelihood of post-discharge onset of serious bone disorders and prevent rehospitalization, according to Nierman.
"We know that elderly patients confined to the ICU for long periods undergo considerable difficulties, including accelerated bone loss related to their hospital stay. The problem is becoming pronounced because a substantial number of these patients are surviving their illnesses and are being discharged to other settings in these conditions," Nierman adds.
The study found an alarming prevalence in muscle weakness linked to metabolic bone loss among critically ill patients. Patients most likely to be at risk are the elderly who suffer from multiple illnesses and survived a life-threatening episode of sepsis. Included in the group are extremely debilitated patients who are ventilator-dependent due to their medical conditions.1
1. Nierman DM, Mechanick JI. Bone hyper-resorption is prevalent in chronically critically ill patients. Chest 1998; 114:1,122-1,128.