Clinical Update: Heart Failure and Osteoporosis-Related Fractures

By: Mahdieh Danesh Yazdi

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Heart failure is a condition in which the heart cannot pump blood efficiently to adequately perfuse tissues. It is often associated with serious consequences, such as kidney failure, liver dam-age, heart attack, and stroke. Patient care is focused on preventing these complications. Recently, attention has turned to other concerns: studies have shown an increased risk of osteoporosis-related fracture in patients with heart failure.

At the 2011 Annual Meeting of the American Society for Bone and Mineral Research, researchers from the University of Alberta presented evidence of an increase in osteoporosis-related fracture risk in those with heart failure. Researchers found that in those diagnosed with heart failure, the risk of fracture was 10% as op-posed to 5% in those who did not have heart failure. The in-creased risk of fractures remained true even after the data was adjusted to account for other co-morbid conditions, risk factors, and total hip bone mineral density. When asked whether the drugs taken for heart failure (e.g. ACE inhibitors, beta-blockers) could potentially be responsible for the increase in fracture risk, researchers indicated that despite adjustments made based on beta-blocker therapy, the data still persistently showed the in-creased risk of fractures. The researchers warned that clinicians must be wary of the dangers that a fracture presents in a patient with heart failure, as these would be more difficult to treat due to the multiple co-morbid conditions often present in patients.

Another study published in the American Journal of Medicine also revealed that there was a slight increase in the number of fractures in those with heart failure. Using information obtained in the Rochester Epidemiology Project, the researchers assessed the risk of fractures in patients with heart failure in Olmstead County, Minnesota. Both, patients with a fracture prior to a diagnosis of heart failure and patients with a fracture after a diagnosis of heart failure, showed an increased risk of an osteoporosis-related fracture. However, this was only true of an increase in hip fractures. There was no increased risk of other fractures in the heart failure group.

Although these studies were not definitive in their conclusions, they did warn against neglecting other, less serious but still dangerous, complications associated with heart failure. Particularly, hip fractures should be examined thoroughly, as they are very frequently seen in these patients. Co-morbid conditions are also of great concern. Those who suffer from heart failure are often older and frailer.

For clinicians, the added risk of fracture attributable to heart failure urges greater awareness.

SOURCES:

• Gerber Y, Melton LJ 3rd, Weston SA, Roger VL. Osteoporotic fractures and heart failure in the community. Am J Med. 2011 May;124(5):418-25.
• Lyons KJ, Majumdar SR, Ezekowitz JA. The unrecognized burden of osteoporosis-related vertebral fractures in patients with heart failure. Circ Heart Fail. 2011 Jul 1;4(4):419-24.
• Melville, NA. (2011, September 20). Heart Failure Associated With Fracture Risk. Medscape. Retrieved from http://www.medscape.com/viewarticle/750022