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Status of bone mineral density in patients selected for cardiac transplantation
Nayyar Iqbal1, Julie Ducharme, Shashank Desai
1Division of Endocrinology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Section of Endocrinology, Department of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA.
Insights
Bone mineral density (BMD) in heart failure patients awaiting transplant was not significantly low. However, some patients showed low vitamin D and high parathyroid hormone levels, indicating potential bone health concerns.
Area of Science:
- Cardiology
- Endocrinology
- Bone Metabolism
Background:
- End-stage heart failure (HF) impacts multiple organ systems.
- Bone mineral density (BMD) assessment is crucial in patients with chronic diseases.
- Cardiac transplant candidates require comprehensive pre-transplant evaluation.
Purpose of the Study:
- To investigate the prevalence of low bone mineral density (BMD) in ambulatory outpatients with end-stage heart failure.
- To identify correlates of low BMD in this specific patient population awaiting cardiac transplantation.
- To establish baseline bone health status before cardiac transplantation.
Main Methods:
- Dual-energy x-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine and proximal femur.
- Fifty-five end-stage heart failure patients awaiting cardiac transplantation were included.
- Laboratory tests included assessment of serum alkaline phosphatase, calcium, intact parathyroid hormone, and 25-hydroxyvitamin D.
Main Results:
- Mean Z scores for proximal femur and lumbar spine were not significantly lower than age- and sex-matched reference populations.
- 23% of patients had lumbar spine Z scores below -1, and 15% had proximal femur Z scores below -1.
- Osteopenia was observed in 24% at the lumbar spine and 20% at the proximal femur; osteoporosis was present in 4%.
Conclusions:
- Ambulatory patients with end-stage heart failure awaiting cardiac transplantation generally maintained normal lumbar spine and hip BMD relative to age and sex.
- A significant proportion of patients exhibited low 25-hydroxyvitamin D levels (33%) and elevated intact parathyroid hormone levels (50%).
- These biochemical findings suggest potential underlying metabolic bone disease despite normal BMD, warranting further investigation and management.
Objective:
To determine the prevalence and correlates of low bone mineral density (BMD) in ambulatory outpatients with end-stage heart failure who were awaiting cardiac transplantation.
Methods:
Fifty-five cardiac transplant candidates with end-stage heart failure were enrolled in this study. Bone mineral density at the lumbar spine and proximal femur was determined by dual-energy x-ray absorptiometry. Laboratory studies included serum alkaline phosphatase, calcium, intact parathyroid hormone, and 25-hydroxyvitamin D.
Results:
The mean proximal femur and lumbar spine Z scores were 0.3 +/- 1.1 and 0.3 +/- 1.5, respectively. The mean BMD was not lower than that of the age-and sex-matched reference population. Z scores were less than -1 in 23% at the lumbar spine and 15% at the proximal femoral neck. On the basis of T scores, osteopenia (T scores between -1 and -2.5) was present in 24% (confidence interval, 13% to 35%) of patients at the lumbar spine and in 20% (confidence interval, 10% to 30%) at the proximal femur; osteoporosis (T scores of less than -2.5) was present in 4% of the study population. Half of the patients in this study sample had elevated intact parathyroid hormone levels, and a third of the patients had low 25-hydroxyvitamin D levels.
Conclusion:
Lumbar spine and hip BMD measurements were not significantly low relative to age and sex in ambulatory patients with heart failure awaiting cardiac transplantation.
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