Heart failure patients’ osteoporosis often undiagnosed, untreated

A Canadian study recently published in the American Heart Association journal Circulation: Heart Failure has found that although one in 10 heart failure patients had compression fractures in the spine that could have been detected by chest X-ray, few are actually receiving treatment to help prevent such fractures.

“As the population ages, two of the most prevalent diseases are heart disease and osteoporosis,” study author Justin A. Ezekowitz, MD, stated in an American Heart Association release. “While hip fractures are the most devastating complication of osteoporosis, vertebral compression fractures are by far the most common. Unfortunately, 60% to 70% of spinal fractures are initially asymptomatic, escaping clinical detection yet placing the patients at higher risk for another vertebral fracture and subsequent hip fractures.”

According to the study abstract, the researchers took a random sample of patients who attended a tertiary care heart failure clinic in Edmonton, Alberta, Canada and conducted a cross-sectional study. This included the collection of sociodemographic, clinical, medication, and chest-radiograph information.

Using documented vertebral compression fracture on chest radiographs as a primary outcome, the researchers utilized multivariable logistic regression to determine the independent correlates of vertebral compression fracture.

In all, 623 patients with heart failure were included in the study. Seventy-seven patients displayed vertebral compression fracture, of which 42 displayed multiple fractures. Only 15% of patients with vertebral compression fractures, the authors reported, were actually treated for osteoporosis. Following a multivariable analysis, it was noted the only predictors that could be independently associated with fracture were atrial fibrillation and lipid-lowering drugs.

The researchers found around a tenth of heart failure patients had a vertebral compression fracture as documented through chest radiographs. Half of these vertebral compression fracture patients had multiple fractures, and most were not on an osteoporosis-specific therapy. Heart failure patients with spinal fractures were older, more likely to be female, and weighed less, according to the release.

“While reviewing chest X-rays to look at the heart and lungs, physicians also need to look carefully at the bones,” Ezekowitz stated in the release. “If fractures are found, patients need to be treated with dietary modification, exercise and, if indicated, osteoporosis medications. Treatment can reduce fractures by as much as 50%.”

Reference:

Lyons K, Majumdar SR, Ezekowitz JA. The unrecognized burden of osteoporosis-related vertebral fractures in patients with heart failure. Circ Heart Fail. Published online before print May 10, 2011, doi: 10.1161/?CIRCHEARTFAILURE.111.961185

www.heart.org

Disclosure: No relevant financial disclosures were reported.

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