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Published on: June 2, 2022
Effects of calcium supplementation on bone loss and fractures in congestive heart failure
Robert J A Frost1, Carolin Sonne, Uli Wehr
1Medizinische Poliklinik, Klinikum Innenstadt, Department of Cardiology, Ludwig-Maximilians University, Munich, Germany.
Insights
Congestive heart failure patients experience bone density loss, particularly with impaired kidney function. Calcium supplements alone do not prevent this bone loss progression in heart failure patients.
Area of Science:
- Cardiology
- Endocrinology
- Bone Metabolism
Background:
- Over 50% of congestive heart failure (CHF) patients exhibit reduced bone mineral density (BMD).
- Longitudinal data on BMD changes and effective treatments for bone loss in CHF are scarce.
Purpose of the Study:
- To investigate longitudinal changes in BMD in male CHF patients.
- To assess the efficacy of calcium supplementation in preventing BMD loss in CHF.
Main Methods:
- A prospective, longitudinal trial involving 33 male CHF patients (ejection fraction: 30+/-11%).
- Patients received either 1000 mg calcium supplementation or no supplementation.
- BMD was measured at the lumbar spine and femoral neck at baseline and after 12 months using dual-energy X-ray absorptiometry.
Main Results:
- High prevalence of osteopenia (33-36%) and osteoporosis (6-15%) was observed.
- Impaired renal function (70%), secondary hyperparathyroidism (42%), and hypogonadism (33%) were common.
- Bone resorption markers correlated negatively with ejection fraction.
- Both supplemented and unsupplemented groups showed BMD reduction; calcium supplementation did not significantly alter this decrease.
- Femoral neck BMD loss occurred primarily in patients with impaired renal function.
Conclusions:
- CHF patients exhibit progressive BMD loss compared to healthy individuals.
- Renal insufficiency and secondary hyperparathyroidism are key drivers of BMD loss in CHF.
- Calcium supplementation alone is insufficient to prevent BMD decline in this population.
Background:
Cross-sectional studies have shown that more than 50% of patients with congestive heart failure (CHF) have decreased bone mineral density (BMD). There is limited knowledge about the longitudinal changes of BMD and how to treat bone loss in patients with CHF.
Methods:
The present study was a prospective, longitudinal trial in which 33 male patients with CHF (ejection fraction (EF): 30+/-11%) were assigned to 1000 mg calcium supplementation or no supplementation. BMD was measured at the lumbar spine (LS) and the femoral neck (FN) by dual-energy X-ray absorptiometry at baseline and after 12 months.
Results:
Osteopenia (LS 33% and FN 36%) and osteoporosis (LS 15% and FN 6%) were frequently seen in these patients; 70% showed impaired renal function, 42% secondary hyperparathyroidism, and 33% hypogonadism. Bone resorption markers were strongly elevated and correlated negatively with the EF. Patients without calcium supplementation revealed a reduction of BMD (LS 1.7% and FN 1.9%) within 12 months. The fracture incidence was 6%. Patients with calcium supplementation also demonstrated a 6% fracture incidence and a decrease in BMD (LS 1.2% and FN 1.6%), which was not significantly different from the untreated group. Loss of BMD at FN was only seen in patients with impaired renal function.
Conclusions:
Patients with CHF demonstrate a progressive decrease in BMD when compared with age-matched healthy individuals. Increased bone resorption due to renal insufficiency with consecutive secondary hyperparathyroidism is a main reason for BMD loss in CHF. Calcium supplementation alone cannot sufficiently prevent the decrease in BMD.
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