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Iron Deficiency and Bone Metabolism in Heart Failure

Ryosuke Sato1,2, Tania Garfias-Veitl1,2, Angelika Hafke3

  • 1Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.

European Journal of Heart Failure
|August 18, 2026
PubMed

Insights

Iron deficiency in heart failure patients is linked to higher bone mineral density, potentially due to altered FGF-23 and vitamin D levels. Further research into bone microstructure is recommended.

Area of Science:

  • Cardiology
  • Endocrinology
  • Bone Metabolism

Background:

  • Iron deficiency (ID) is prevalent in chronic heart failure (HF).
  • ID may negatively impact bone metabolism in HF patients.
  • The interplay between ID, bone mineral density (BMD), and specific biomarkers is not fully understood.

Purpose of the Study:

  • To investigate the association between ID and BMD in chronic HF patients.
  • To explore the potential mediating roles of fibroblast growth factor 23 (FGF-23) and 1,25-dihydroxy vitamin D (1,25(OH)2 vitamin D) in this relationship.
  • To analyze data from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) cohort.

Main Methods:

  • Defined ID as transferrin saturation (TSAT) <20%.
  • Analyzed BMD, serum FGF-23, and plasma 1,25(OH)2 vitamin D levels in 198 chronic HF patients.
  • Utilized multivariable analyses to assess associations and potential mediation.

Main Results:

  • A significant proportion of patients (29.8%) had ID (TSAT <20%).
  • ID was associated with higher BMD (p=0.009) and a dose-response relationship was observed across TSAT quartiles (p for trend=0.0009).
  • ID correlated with elevated FGF-23 and reduced 1,25(OH)2 vitamin D. Lower 1,25(OH)2 vitamin D was independently associated with higher BMD (aOR 0.54, p=0.002).

Conclusions:

  • In chronic HF, ID (TSAT <20%) is linked to disturbed bone metabolism.
  • Increased FGF-23 and decreased 1,25(OH)2 vitamin D may mediate this association.
  • Further investigation into bone microstructure in HF patients with ID is warranted.
Abstract

Keywords:
1,25-dihydroxy vitamin Dbone mineral densityfibroblast growth factor 23heart failureiron deficiency

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