HF heightened risk for major bone fractures in patients with osteoporosis

Majumdar SR. J Clin Endocrinol Metab. 2012;doi:10.1210/jc.2011-3055.

Issue: March 2012

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 conditions.”

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 financial disclosures.

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