Heart failure heightened risk for major bone fractures in patients with osteoporosis

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

New data show that, independent of traditional risk factors and bone mineral density, heart failure is associated with a 30% increased risk for major fractures, suggesting that this high-risk population may benefit from increased screening and treatment.

“Our study demonstrates for the first time that heart failure and thinning of bones go hand in hand,” study researcher 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 BMD results from a clinical registry of patients (mean age, 66 ± 10 years; 92% women) who underwent initial BMD testing from 1998 to 2009. Time to major osteoporotic fractures was the main outcome measure.

Of the 45,509 patients aged at least 50 years included in the cohort, 4% had recent-onset heart failure. Compared with those without heart failure, these patients were significantly older (74 years vs. 66 years; P<.001); experienced more previous fractures (21% vs. 13%); and had lower total hip BMD 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 heart failure patients vs. 5% of those without heart failure (unadjusted HR=2.45; 95% CI, 2.11-2.85), according to study results. The association between heart failure 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 BMD (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 heart failure and osteoporosis. Study results also indicate that a patient diagnosed with heart failure 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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