Fracture Risk in Men With Congestive Heart Failure

Carbone, Laura D; Cross, Jason; Raza, Syed Hasan; Bush, Andrew; Sepanski, Robert; Dhawan, Saurabh S.; Khan, Bilal; Gupta, Monica; Ahmad, Khurram; Khouzam, Rami N.; Dishmon, Dwight A.; Nesheiwat, Joseph P.; Hajjar, Mohammad A.; Chishti, Waqas; Nasser, Wael; Khan, Mohd Shahbaaz; Womack, Catherine; Cho, Tara; Haskin, Ashley R.; Weber, Karl T.

doi:10.1016/j.jacc.2008.03.039

Cited by 74 publications

(43 citation statements)

References 33 publications

(23 reference statements)

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“…11 A case-control study of male veterans also demonstrated that fewer fractures were seen in those patients on spironolactone. 21 Vitamin D levels are lower in HF patients than in age-matched control subjects, 22 and deficiency of 25-hydroxy-vitamin D was a risk factor for future cardiac events in the Framingham cohort. 23 However, a small randomized trial of vitamin D supplementation in patients with HF did not alter survival or echocardiographic parameters but did improve markers of inflammation and other biochemical markers of secondary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 94%

Heart Failure Is a Risk Factor for Orthopedic Fracture

et al. 2008

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Background— Heart failure (HF) is associated with factors that may contribute to accelerated bone loss and subsequent fractures. Whether it leads to an increased fracture risk is unknown. Methods and Results— A population-based cohort of consecutive patients ≥65 years of age with cardiovascular disease presenting to all emergency rooms between 1998 and 2001 in Alberta, Canada (n=16294 patients), was used. The 2041 patients with a new diagnosis of HF were compared with a control group of 14 253 patients with non-HF cardiovascular diagnoses. The primary outcome was any orthopedic fracture requiring hospital admission in the year after the emergency room visit. Patients with HF had a median age of 78 years (interquartile range, 72 to 84 years), and 51.9% were female; control subjects had a median age of 73 years (interquartile range, 68 to 79 years), and 53.2% were female. In the first year after the emergency room visit, 4.6% of the HF cohort (n=93) and 1.0% of patients without HF (n=147) sustained an orthopedic fracture ( P <0.001). Hip fractures occurred in 26 HF patients (1.3%) and 18 patients (0.1%) without HF ( P <0.001). After multivariable adjustment, HF was independently associated with a greater risk of any orthopedic fracture (adjusted odds ratio, 4.0; 95% CI, 2.9 to 5.3) or hip fracture (adjusted odds ratio, 6.3; 95% CI, 3.4 to 11.8). Conclusions— HF is associated with an increased risk of subsequent orthopedic fracture, particularly hip fracture. This suggests that screening for and treatment of osteoporosis to reduce fracture risk need to be considered in those with HF.

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Section: Discussionmentioning

confidence: 94%

Heart Failure Is a Risk Factor for Orthopedic Fracture

et al. 2008

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“…(18) The mechanisms by which mineralcorticoids may affect bone are still unknown and have been poorly investigated. (7,18) In our opinion, the observed skeletal involvement may be a result of, at least partially, increased urinary calcium excretion and consequent secondary hyperparathyroidism. This has already been observed in some previous studies in humans.…”

Section: Discussionmentioning

confidence: 99%

Bone involvement in aldosteronism

Salcuni

Palmieri

Carnevale

et al. 2012

Journal of Bone and Mineral Research

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In rats with aldosteronism, a reduction of bone mineral density (BMD) and cortical bone strength has been reported. Our study was aimed to evaluate bone involvement in patients with primary aldosteronism (PA). A total of 188 consecutive subjects with adrenal incidentaloma, observed between November 2009 and October 2011, were screened for PA with aldosterone-to-renin ratio. After confirmatory tests, in those who screened positive, 11 patients were diagnosed as PA and 15 patients were not (nPA). A serum/urinary biochemical profile, parathyroid hormone (PTH), BMD measured at lumbar spine (LS) and total and femoral neck (TN and FN) by dual X-ray absorptiometry, and conventional spinal radiographs (T 4 -L 4 ) were obtained in all subjects. PA patients had a significantly higher 24-hour urinary calcium (6.28 AE 1.85 versus 4.28 AE 1.18 mmol/d; p < 0.01), and PTH (9. 8 [5.8-14.6 p ¼ 0.012; and OR, 30.4; 95%CI,, p ¼ 0.045, respectively) regardless of age, body mass index (BMI), and LS-BMD. In 9 of 11 PA patients, 6 months after beginning of treatment (surgery or spironolactone) there was a significant reduction of urinary calcium excretion (p < 0.01) and PTH (p < 0.01), whereas in 5 of 11 PA patients, 1 year after beginning of treatment, BMD was significantly increased at LS, p < 0.01). In conclusion, PA is associated with osteoporosis, vertebral fractures, and increased urinary calcium excretion. ß

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“…31 Furthermore, in one case-control study, HF patients treated with spironolactone were significantly less likely to have a fracture than HF patients not treated with an aldosterone antagonist-a finding that we were unable to replicate but deserves further attention. 32 In addition, increased levels of aldosterone lead to atrial fibrosis and subsequent atrial fibrillation, both of which can be reduced by treatment with spironolactone. 33,34 Future studies exploring whether atrial fibrillation is a risk factor for fracture in populations across a spectrum of patients with available aldosterone levels are needed.…”

Section: Discussionmentioning

confidence: 99%

The Unrecognized Burden of Osteoporosis-Related Vertebral Fractures in Patients With Heart Failure

Lyons

Majumdar

2011

Circ: Heart Failure

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Background-Heart failure (HF) is associated with several factors that contribute to both reduced bone mineral density and increased risk of osteoporosis-related fractures. Our objectives were to describe the prevalence and predictors of the most common osteoporotic fracture, vertebral compression fractures (VCF), in patients with HF. Methods and Results-We conducted a cross-sectional study in a random sample of patients attending a tertiary care HF Clinic in Edmonton, Alberta, Canada. We collected sociodemographic, clinical, medication, and chest radiograph information. Primary outcome was board-certified radiologist-documented VCF on chest radiographs. Multivariable logistic regression was used to determine independent correlates of VCF. Overall, 623 patients with HF were included; 32% were over 75 years of age, 31% were women, 65% had ischemic cardiomyopathy, and 38% had atrial fibrillation.

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Fracture Risk in Men With Congestive Heart Failure

Abstract: The use of spironolactone is inversely associated with fractures in men with CHF.

Cited by 74 publications

References 33 publications

Heart Failure Is a Risk Factor for Orthopedic Fracture

Heart Failure Is a Risk Factor for Orthopedic Fracture

Bone involvement in aldosteronism

The Unrecognized Burden of Osteoporosis-Related Vertebral Fractures in Patients With Heart Failure

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