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Heart failure is associated with accelerated age related metabolic bone disease
Pieter Martens1,2, Jozine M Ter Maaten3, Dimitri Vanhaen1
1Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Insights
Heart failure (HF) is independently linked to metabolic bone disease (MBD) and a higher osteoporosis risk. HF accelerates age-related bone density loss, but some medications may offer protection.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Heart failure (HF) is associated with factors like neuro-hormonal activation, chronic kidney disease (CKD), and altered phosphorus metabolism, all influencing bone density.
- The independent role of HF in metabolic bone disease (MBD) requires further clarification.
Purpose of the Study:
- To investigate the association between HF and MBD, specifically osteoporosis.
- To determine if HF is an independent risk factor for reduced bone mineral density.
Main Methods:
- Dual X-ray absorptiometry (DEXA) was used to assess bone density in HF patients and matched controls.
- Correlation and Z-score analyses were employed to evaluate HF's impact on age-related bone demineralization.
- Statistical adjustments were made for known osteoporosis risk factors, baseline characteristics, kidney function, and phosphorus metabolism.
Main Results:
- HF patients exhibited a higher prevalence of osteoporosis (26% vs. 17%) and lower average bone mineral density, T-scores, and Z-scores compared to controls.
- Even after adjusting for confounding factors, HF remained independently associated with lower average T-scores (Adjusted β = -0.189; p = .017).
- HF was linked to accelerated age-related bone density decline. ACE inhibitors/ARBs and beta-blockers showed protective effects, while loop diuretics worsened bone demineralization.
Conclusions:
- Heart failure is an independent risk factor for MBD and increases osteoporosis prevalence.
- HF exacerbates age-related bone density loss, with potential amelioration observed with neuro-hormonal blocking therapies.
Background:
The heart failure (HF)-syndrome is associated with neuro-hormonal activation, chronic kidney disease (CKD), inflammation and alterations in the phosphorus-metabolism, all of which are involved in regulation of mineral bone density. However, the role of HF as an independent factor associated with metabolic bone disease (MBD) remains unclear.
Methods:
HF-patients undergoing dual X-ray absorptiometry (DEXA) were matched in a 1:2 fashion against age and gender matched controls without HF, to determine the proportion of osteoporosis (T-score < -2.5). HF-status was tested against known predictors of MBD. Correlation analysis and Z-score analysis were used to assess the impact of HF on age-related bone demineralisation.
Results:
A total of 190 HF-patients (age = 80 ± 10 years, female = 61%) were age and gender matched to 380 controls. HF-patients had a higher proportion of osteoporosis (26 vs 17%; p = .007). HF patients had a lower averaged mineral bone density expressed in g/cm2 (p = .030), T-scores (p = .001) and Z-scores (p < .001). After adjusting for the individual osteoporosis risk-factors of the FRAX-score, difference in baseline features, kidney function and phosphorus-metabolism alterations, heart failure remained independently associated with a lower averaged T-score (Adjusted β = -0.189; p = .017). Heart failure was associated with an accelerated age-related decline in mineral bone density (p = .0418). Therapies with ACE-I or ARBs and beta-blockers associated with ameliorated bone demineralisation (p = .023, respectively p = .029), while loop diuretic associated with worsened bone demineralization (p < .001).
Conclusion:
Heart failure independently associates with MBD and higher prevalence of osteoporosis. Heart failure aggravates the aged related loss in mineral bone density while treatment with neuro-hormonal blockers seemed to ameliorate this finding.
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