Intravenous ibandronate acutely reduces bone hyperresorption in chronic critical illness.

Objective: Patients who remain critically ill for prolonged periods and require tracheotomy, defined as chronic critical illness (CCI), display elevated levels of bone resorption. The measurement of bone turnover markers reveals that osteoclastic bone resorption is not only enhanced but also uncoupled from osteoblastic bone formation. We examine the effect of ibandronate on bone turnover in patients with CCI.

Bisphosphonates and metabolic bone disease in the ICU.

Purpose Of Review: The purpose of this review is to discuss the elements of critical illness that predispose to rapid and severe bone loss and illustrate how potent nitrogen containing intravenous bisphosphonates can mitigate this potentially serious disease.

Recent Findings: Recent studies confirm that inflammatory cytokines, immobilization, and hormonal irregularities incite osteoclast-mediated bone resorption. Bisphosphonates are antiresorptive agents and well suited to treat this bone loss.

Complementary and alternative medicine and the management of the metabolic syndrome.

More than one third of the population has the metabolic syndrome. Although aspects of the metabolic syndrome (MSDR) are readily treatable with evidence-based interventions, many patients and practitioners are looking for alternatives to pills and injectables. Complementary and alternative medicine may offer patients safe and effective options to target components of MSDR.

Nutrition support and the chronic critical illness syndrome.

Critical illness can be viewed as consisting of 4 distinct stages: (1) acute critical illness (ACI), (2) prolonged acute critical illness, (3) chronic critical illness, and (4) recovery. ACI represents the evolutionarily programmed response to a stressor. In ACI, substrate is shunted away from anabolism and toward vital organ support and inflammatory proteins.