HF is associated with a 30% increased risk for major
fractures, independent of traditional risk factors and bone mineral density,
suggesting that this high-risk population may benefit from increased screening
and treatment, according to recent data.
“Our study demonstrates for the first time that
heart failure and thinning of bones go hand in hand,”
Sumit R. Majumdar, MD, of the University of Alberta in Edmonton, Canada,
said in a press release. “Understanding the mechanism between heart
failure and osteoporosis might lead to new treatments for both
Majumdar and colleagues collected osteoporosis risk
factors, comorbidities, medications and bone mineral density results from a
clinical registry of patients (mean age, 66; 92% women) who underwent initial
bone mineral density testing from 1998 to 2009. Time to major osteoporotic
fractures was the main outcome measure.
Of 45,509 patients aged at least 50 years included in
the cohort, 4% had recent-onset HF. Compared with those without HF, these
patients were significantly older (74 years vs. 66 years; P<.001);
experienced more previous fractures (21% vs. 13%); and had lower total hip bone
mineral density T-scores (–1.3 vs. –0.9).
During 5 years of observation, researchers found 2,703
incident major osteoporotic fractures. Incident major fractures occurred in 10%
of HF patients vs. 5% of those without HF (unadjusted HR=2.45; 95% CI,
2.11-2.85). The association between HF and incident fracture weakened with
adjustment for osteoporosis risk factors, comorbidities and medications
(HR=1.33; 95% CI, 1.11-1.60). Similar results were found for total hip bone
mineral density (HR=1.28; 95% CI, 1.06-1.53).
Majumdar and colleagues said the study findings open new
avenues for research, such as examining mechanistic links between HF and
osteoporosis. Study results also indicate that a patient diagnosed with HF
should receive more attention when it comes to their bone health.
“Part of screening for osteoporosis should
involving looking at chest X-rays of patients with heart failure,”
Majumdar said. “Heart failure patients get a lot of X-rays and they often
incidentally show many fractures of the spine that would automatically provide
an indication of severe osteoporosis and need for treatment.”
Disclosure: Dr. Majumdar reports no relevant