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Heart failure as a risk factor for osteoporosis and fractures
Aloice O Aluoch1, Ryan Jessee, Hani Habal
1Department of Medicine, University of TN Health Science Center, Memphis, 38163, USA.
Insights
Heart failure (HF) patients face a higher risk of osteoporosis, influenced by gender and HF severity. Shared risk factors and treatments impact both conditions, necessitating careful osteoporosis assessment in HF patients.
Area of Science:
- Gerontology
- Cardiology
- Endocrinology
Background:
- Heart failure (HF) and osteoporosis are prevalent, particularly in older adults.
- Patients with HF exhibit an elevated risk for developing osteoporosis.
- The interplay between HF and osteoporosis is influenced by patient demographics and disease severity.
Purpose of the Study:
- To explore the relationship between heart failure and osteoporosis.
- To identify shared risk factors, medication effects, and pathogenic mechanisms.
- To emphasize the importance of osteoporosis management in HF patients.
Main Methods:
- Review of existing literature on HF and osteoporosis.
- Analysis of shared risk factors such as age, vitamin D deficiency, renal disease, and diabetes.
- Examination of medication effects (e.g., spironolactone, loop diuretics) on bone health.
- Investigation of common pathophysiological pathways like the renin-angiotensin-aldosterone system and oxidative stress.
Main Results:
- Shared risk factors including advanced age, hypovitaminosis D, renal disease, and diabetes mellitus contribute to both conditions.
- Certain HF medications (spironolactone, thiazide diuretics, nitric oxide donors, aspirin) may offer bone protection, while loop diuretics may exacerbate osteoporosis.
- Common pathogenic mechanisms include renin-angiotensin-aldosterone system activation, elevated parathyroid hormone, and oxidative/nitrosative stress.
Conclusions:
- Heart failure is a significant risk factor for mortality after fractures.
- Comprehensive osteoporosis screening and preventive measures are crucial for patients with heart failure.
- Understanding the shared pathophysiology can guide integrated management strategies for HF and osteoporosis.
Abstract:
Although heart failure (HF) and osteoporosis are common diseases, particularly in elderly populations, patients with HF have an increased risk for osteoporosis. The relationship of HF with osteoporosis is modified by gender and the severity of HF. In addition, shared risk factors, medication use, and common pathogenic mechanisms affect both HF and osteoporosis. Shared risk factors for these 2 conditions include advanced age, hypovitaminosis D, renal disease, and diabetes mellitus. Medications used to treat HF, including spironolactone, thiazide diuretics, nitric oxide donors, and aspirin, may protect against osteoporosis. In contrast, loop diuretics may make osteoporosis worse. HF and osteoporosis appear to share common pathogenic mechanisms, including activation of the renin-angiotensin-aldosterone system, increased parathyroid hormone levels, and/or oxidative/nitrosative stress. HF is a major risk factor for mortality following fractures. Thus, in HF patients, it is important to carefully assess osteoporosis and take measures to reduce the risk of osteoporotic fractures.
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