Heart Failure Is a Risk Factor for Orthopedic Fracture

Abstract

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.

Oxidative stress and bone mineral density in elderly men: Antioxidant activity of alpha-tocopherol

“…When these were treated with the potent free radical scavenger N-acetylcysteine, the release was inhibited [36]. Oxidative stress is a potential link between osteoporosis and known risk factors such as heart failure [37], smoking [38], and hypertension [39] and this link may at least partly be mediated by NF-κβ with its important role in modulating the expression of many genes involved in cell proliferation, differentiation, apoptosis, stress response, cell signalling transduction, inflammation, and other pathophysiological processes. Oxidative stress may also influence osteoblastogenesis and bone formation, where the Wnt-β-catenin pathway has emerged as a central regulator [40].…”

Association between cardiovascular diseases and osteoporosis—reappraisal

“…The associations are significant in the studies, which assess fragility fractures, mainly hip fracture on the side of osteoporosis and, on the side of CVD, myocardial infarction, stroke, heart failure or severe AAC. 1,5,6,25,35,38,43 By contrast, the results are less consistent in the studies in which mild forms of these pathologies were also taken into account. 2,10,11,21,41 More importantly, concomitant heart failure is a risk factor of mortality in hip fracture patients, whereas hip fracture confers a risk of mortality in patients with heart failure.…”

“…Finally, elderly patients with heart failure and patients with other cardiovascular diagnoses were identified in the healthcare databases of the province Alberta, Canada. 25 The controls with CVD were selected because they can share some cardiovascular risk factors and potentially be eligible for similar medications. Patients with heart failure had a fourfold higher risk of sustaining any fracture requiring hospitalization compared with other cardiovascular diagnoses.…”

Alterations of Serum Parathormone, Calcium, and Vitamin D Levels in End-Stage Heart Failure Cases Performed with Left Ventricular Assist Device Implantation

“…Kalp yetmezlikli hasta grubunda mobilizasyon kısıtlılığı ve özellikle güneşe maruziyetin azalmasının da vitamin D sentezinde bozulmaya yol açarak PTH yüksekliğine sebep olduğu bildirilmektedir (3-6). Bu süreçlerin sonucu olarak azalmış KMY ile gösterilebilen ilerleyici osteoporoza bağlı gelişebilen patolojik kırıklar, fonksiyonel kapasitesi ve mobilizasyonu zaten kısıtlı olan SDKY hastalarının morbidite ve mortalitesinin artmasına yol açmaktadır (7)(8)(9) Literatürdeki benzer çalışmalarda da, hastaların tedavisine eklenen vitamin D takviyelerinin mortalite ve morbidite üzerine anlamlı etkileri olduğu gösterilmiştir (17)(18)(19). Son iki dekaddır SDKY tedavisinde tüm dünyada etkin şekilde uygulanan SVDC implantasyon cerrahisi sonrasındaki hızlı metabolik ve fonksiyonel düzelmenin kalsiotropik hormonlar dolayısıyla KMY üzerine etkisi henüz tam olarak aydınlatılamamıştır.…”

“…Bu olguların giderek artan mobilizasyon problemleri ve özellikle ev dışı fiziksel aktivitelerinin azalmış olması da, güneş ışığı bağımlı 25-hidroksivitamin D (25-OH-D) sentezinin bozulmasına yol açarak, osteoporoz gelişimini kaçınılmaz kılmaktadır (3)(4)(5)(6). Azalmış kemik mineral yoğunluğu (KMY) ile gösterilebilen ilerleyici osteoporoz sonucu olarak gelişebilen patolojik kırıklar, hali hazırda fonksiyonel kapasitesi ve mobilizasyonu kısıtlı olan SDKY hastalarının morbidite ve mortalitesinin artmasına yol açmaktadır (7)(8)(9). Son iki dekaddır SDKY tedavisinde kullanıma giren sol ventriküler destek cihazı (SVDC) implantasyonu ile hastaların fonksiyonel kapasitelerinin arttığı, hipoperfüzyona sekonder bozulmuş böbrek ve karaciğer fonksiyonlarının düzelttiği bilinmektedir (10).…”