Обзор американских кардиологических журналов за неделю (ссылки)

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ASBMR: Heart Failure Raises Fracture Risk
By Nancy Walsh, Staff Writer, Published: September 17, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


Explain that heart failure in older adults increases their likelihood of osteoporotic fractures by almost 30%, independent of risk factors and bone mineral density (BMD).

SAN DIEGO -- Heart failure in older adults increases their likelihood of osteoporotic fractures by almost 30%, independent of risk factors and bone mineral density (BMD), Canadian researchers reported here.

Among adults 50 and older in Manitoba who had their first BMD test between 1998 and 2007, 10% of those with heart failure developed a major fracture over a five-year period compared with only 5% of those without heart failure, according to Sumit Majumdar, MD, of the University of Alberta.

The unadjusted hazard ratio (HR) for fracture in patients with heart failure was 2.45 (95% CI 2.11 to 2.85, P<0.001), he reported.

"Both osteoporosis and heart failure are common and costly conditions that are underdiagnosed and undertreated, and they share etiologic features such as older age, smoking, and diabetes," Majumdar said at the annual meeting of the American Society for Bone and Mineral Research.

Several recent studies have suggested an association between osteoporosis and heart failure, but none of them have included measures of BMD.

To further explore the possible evidence of a connection, the researchers analyzed data from administrative sources and an osteoporosis clinical registry. They obtained information on heart failure diagnoses as well as nontraumatic fractures of the vertebrae, hip, distal radius, and humerus. Patients were followed until 2009.

The cohort included 45,509 adults, 1,841 of whom had been diagnosed with heart failure within the previous two years.

The 4% of the population who had heart failure were more often men (17% versus 7%) and older (74 versus 66 years).

In addition, they had lower total hip T scores (−1.3 versus −0.9, P<0.001) and had experienced significantly more previous osteoporotic fractures (21% versus 13%), Majumdar said.

A total of 40% of patients with heart failure had a T score at any site below −2.5, compared with 29% of those without heart failure.

And 60% of the heart failure group were taking loop diuretics, which are known to increase fracture risk, compared with only 4% of the larger population, which was a 15-fold difference, he observed.

There were 2,703 major fractures during a median follow up of five years.

"In terms of fracture-free survival, the Kaplan-Meier survival curves started to separate shortly after the first bone mineral density test and continued to diverge out to ten years. The median time to fracture was 3.6 years," Majumdar reported.

The HR for fracture in patients with heart failure after adjustment for age and sex was 1.64 (95% CI 1.45 to 1.86).

After adjustment for comorbidities, osteoporosis risk factors, and the effects of medications, the HR was 1.33 (95% CI 1.11 to 1.60, and remained elevated even after adjustment for total hip BMD (HR 1.28, 95% CI 1.06 to 1.53).

"This meant that patients with heart failure had a 28% increased fracture risk over five years regardless of risk factors or BMD scores," he said.

Limitations of the study included the absence of radiographic confirmation of fractures and a lack of measures of heart failure severity such as ejection fraction.

"Important implications of the study were that it opens up new avenues for research in terms of mechanisms of the diseases. Clinically, we need to recognize that a diagnosis of heart failure portends an increased risk of fracture, so we should be paying much more attention to bone health in patients with heart failure," Majudar concluded.