The unrecognized burden of osteoporosis-related vertebral fractures in patients with heart failure
Kristin J Lyons1, Sumit R Majumdar, Justin A Ezekowitz
1Department of Medicine, University of Alberta, Edmonton, Canada.
Insights
Heart failure patients frequently experience vertebral compression fractures (VCF), often multiple, with most untreated. Atrial fibrillation emerged as a novel risk factor for VCF in this population.
Area of Science:
- Cardiology
- Orthopedics
- Geriatrics
Background:
- Heart failure (HF) is linked to reduced bone density and increased fracture risk.
- Vertebral compression fractures (VCF) are common osteoporotic fractures in HF patients.
Purpose of the Study:
- To determine the prevalence and predictors of VCF in patients with heart failure.
Main Methods:
- Cross-sectional study of 623 HF patients.
- Chest radiographs analyzed for VCF.
- Multivariable logistic regression used to identify independent correlates.
Main Results:
- VCF prevalence was 12% (77/623), with 55% having multiple fractures.
- Only 15% of VCF patients received osteoporosis treatment.
- Atrial fibrillation (OR 2.1) and lipid-lowering drugs (OR 0.2) were independently associated with VCF.
Conclusions:
- VCF is common in HF patients, often undiagnosed and untreated.
- Atrial fibrillation is a newly identified risk factor for VCF in HF.
- Chest radiographs can aid in identifying VCF in HF patients, especially those with atrial fibrillation.
Background:
Heart failure (HF) is associated with several factors that contribute to both reduced bone mineral density and increased risk of osteoporosis-related fractures. Our objectives were to describe the prevalence and predictors of the most common osteoporotic fracture, vertebral compression fractures (VCF), in patients with HF.
Methods And Results:
We conducted a cross-sectional study in a random sample of patients attending a tertiary care HF Clinic in Edmonton, Alberta, Canada. We collected sociodemographic, clinical, medication, and chest radiograph information. Primary outcome was board-certified radiologist-documented VCF on chest radiographs. Multivariable logistic regression was used to determine independent correlates of VCF. Overall, 623 patients with HF were included; 32% were over 75 years of age, 31% were women, 65% had ischemic cardiomyopathy, and 38% had atrial fibrillation. Prevalence of VCF was 77 of 623 (12%; 95% confidence interval, 10% to 15%), and 42 of 77 (55%) patients had multiple fractures. Only 15% of those with VCF were treated for osteoporosis. In multivariable analyses adjusted for age, female sex, weight, and medications, the only remaining predictors independently associated with fracture were atrial fibrillation (present in 42 of 77 [55%] of those with VCF versus 197 of 540 [36%] of those without; adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.6; P=0.009) and lipid-lowering drugs (used by 36 of 77 [47%] of those with VCF versus 342 of 540 [63%] of those without; adjusted odds ratio, 0.2; 95% confidence interval, 0.1 to 0.9; P=0.03).
Conclusions:
About one-tenth of HF patients had a chest radiograph-documented VCF, and half of those with VCF had multiple fractures; most (85%) were not receiving an osteoporosis-specific therapy. A previously unrecognized risk factor-atrial fibrillation-was found to be independently associated with VCF. Chest radiograph reports may represent an important case-finding tool for osteoporosis-specific VCF, particularly in HF patients with atrial fibrillation.
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