Heart Failure Raises Risk of Fractures

MONDAY Oct. 20, 2008 -- People with heart failure face a higher risk of fractures, particularly of potentially crippling breaks in the hip bones, new Canadian research finds.

The study of more than 16,000 heart disease patients treated at emergency rooms in the province of Alberta found a more than fourfold higher incidence of fractures among the 2,000 of them with heart failure. The report is in the Nov. 4 issue of Circulation.

Overall, 4.6 percent of those with heart failure, the progressive loss of the heart's ability to pump blood, had broken bones in the year after the emergency room visit, compared to only 1 percent of people with other heart conditions. The one-year rate for hip fractures was 1.3 percent for those with heart failure, compared to 0.1 percent of those with other heart conditions.

While a 1997 study found a hint of low bone density among people getting heart transplants because of heart failure, "this is the first large-scale study of heart failure and fracture rate," said study author Dr. Justin A. Ezekowitz, director of the Heart Function Clinic at the University of Alberta, in Edmonton.

The finding has several important implications for people with heart failure and the doctors who treat them, Ezekowitz said. The higher incidence of hip fractures is especially worrying, he said, since, "they can be seriously debilitating for older folks, increasing the risk of blood clots to the legs and development of pneumonia."

"First, we need appropriate treatment of osteoporosis for patients with heart failure," Ezekowitz said. "Second, we need to encourage heart failure patients to maintain exercise and good nutrition."

Osteoporosis is loss of bone mass that increases the risk of fracture. Exercise and proper dieting are recommended to help prevent the condition.

It's not clear why heart failure should lead to weaker bones, Ezekowitz said. One theory is that the diuretic drugs often prescribed for people with heart failure might be bad for the bones, he said. Another possibility is the higher level of parathyroid hormone, which handles calcium and magnesium, often seen in heart failure could have a bone-weakening effect.

Physicians treating people for heart failure need to be more aware of the risk of fractures, said Dr. Mariell L. Jessup, director of the heart failure and transplant program at the University of Pennsylvania and a spokeswoman for the American Heart Association.

"When patients have such a severe disease, we tend to ignore the other problems they might have," Jessup said. "There is good reason to focus on the total patient, and not just their heart failure."

Awareness of the vitamin D status of someone with heart failure is important, both Jessup and Ezekowitz said. Vitamin D is directly involved in bone strength. But both expressed doubts about using vitamin D supplements specifically for heart failure patients.

"People should be on vitamin D supplements according to the guidelines for osteoporosis care," Ezekowitz said. "There haven't been a lot of clinical trials testing vitamin D supplements in heart failure patients."

Asked about vitamin D, Jessup said, "I treat heart disease. I leave that question to the endocrinologists."

Posted: October 2008


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