Heart Failure Patients have Four Times Greater Risk
of Fractures than Other Heart Patients
These patients should be screened and treated for
osteoporosis if necessary
Oct. 24, 2008 - Heart failure patients are at
higher risk for fractures, including debilitating hip fractures, than
other heart patients and should be screened and treated for
osteoporosis, Canadian researchers report in Circulation: Journal of
the American Heart Association. The average age of the heart failure
patients in the study was 78.
ne year after an emergency room visit, 4.6 percent
of heart failure patients experienced a fracture compared to only 1
percent of other heart patients. The one-year rate for hip fractures was
1.3 percent for heart failure patients compared to only 0.1 percent for
other heart patients.
Thiazolidinediones medications (including rosiglitazone
(Avandia)
produced a significantly increased risk of heart attack, congestive
heart failure and death
After researchers adjusted for other risk factors,
heart failure patients had four times the risk of fracture and 6.3 times
the risk of hip fracture as patients with heart attacks, chest pain or
rhythm disturbances.
This is the first study to link heart failure
patients to a higher risk of fractures, said Justin A. Ezekowitz, M.D.,
senior author of the study and director of the Heart Function Clinic and
assistant professor of medicine at the University of Alberta in Canada.
According to the study, heart failure is a leading
cause of hospitalizations and death, occurring in 2.2 percent of the
general population and 8.4 percent of those older than age 75.
Osteoporosis occurs in about 25 percent of women
and 12 percent of men older than 50 years. Heart failure and
osteoporosis also share common risk factors such as older age, female
sex, smoking and type-2 diabetes.
About Heart Diseases
Also called: Cardiac disease
If you're like most
people, you think that heart disease is a problem for other
folks. But heart disease is the number one killer in the U.S. It
is also a major cause of disability.
There are many
different forms of heart disease.
The most common
cause of heart disease is narrowing or blockage of the coronary
arteries, the blood vessels that supply blood to the heart
itself. This is called
coronary
artery disease and happens slowly over time. It's the
major reason people have
heart
attacks.
Other kinds of heart problems may happen
to the
valves
in the heart, or the heart may not pump well and cause
heart
failure. Some people are
born
with heart disease.
You can help reduce your risk of heart
disease by taking steps to control factors that put you at
greater risk:
● Control your
blood
pressure
● Lower your
cholesterol
● Don't smoke
● Get enough exercise
Heart failure is a condition in which the
heart can't pump enough blood throughout the body. Heart failure
does not mean that your heart has stopped or is about to stop
working. It means that your heart is not able to pump blood the
way it should.
The weakening of the heart's pumping
ability causes
● Blood and fluid to back up into the lungs
● The buildup of fluid in the feet, ankles and legs - called
edema
● Tiredness and shortness of breath
Each year over a million people in the
U.S. have a heart attack. About half of them die. Many people
have permanent heart damage or die because they don't get help
immediately. It's important to know the symptoms of a heart
attack and call 9-1-1 if someone is having them.
Those symptoms include
● Chest discomfort - pressure, squeezing, or pain
● Shortness of breath
● Discomfort in the upper body - arms, shoulder, neck, back
● Nausea, vomiting, dizziness, lightheadedness, sweating
These symptoms can sometimes be different
in
women.
What exactly is a heart attack? Most
heart attacks happen when a clot in the coronary artery blocks
the supply of blood and oxygen to the heart. Often this leads to
an irregular heartbeat called an
arrhythmia - that causes a severe decrease in the pumping
function of the heart. A blockage that is not treated within a
few hours causes the affected heart muscle to die.
The study included 16,294 patients with heart
disease presenting at emergency rooms in Alberta, Canada from 1998 to
2001. Slightly more than 2,000 patients, average age 78, presented with
a new diagnosis of heart failure. The primary outcome was fracture
requiring hospital admission at one year follow-up that was not due to
trauma or other disease.
Researchers excluded patients with hospitalization
for heart failure two years prior to the ER visit and patients with
conditions known to modify fracture or fall risk.
Researchers ascertained prescription medication use
based on database claims 60 days prior to and 60 days after the
emergency room visit.
The use of bisphosphonates and other osteoporosis
medications was higher in the non-heart failure control group. But even
when researchers excluded these patients, the risk of fracture was of
similar magnitude.
Even after adjusting for medications known to
affect the bones, dosages and co-morbidities, heart failure patients had
a fourfold higher risk of fracture, Ezekowitz said.
Women have higher
rates of osteoporosis, but when researchers controlled for gender with
age-matched controls, heart failure patients still had higher fracture
rates than other heart patients.
The reasons for this are unclear, Ezekowitz said.
It may be that heart failure patients arent getting enough calcium or
vitamin D.
Furthermore they noted, parathyroid hormone, which
handles calcium and magnesium affecting bone growth and rebuilding, may
elevate as heart failure worsens. Two other possible reasons are dietary
intake and less exercise.
Most heart failure patients are placed on a strict
diet, but some dont adhere to the diet or are less inclined to eat,
Ezekowitz said.
Additionally, people with heart failure exercise less
due to fatigue and a lower exercise tolerance. Lack of exercise can
weaken the bones.
Findings from the study identified important areas
for immediate improvements, he said. Most of these patients didnt get
adequate screening despite meeting the criteria for screening with a
bone mineral density testing because of their age. And only a handful of
heart failure patients were being treated for osteoporosis.
Fractures, especially hip fractures, can be
devastating in older adults.
Hip fracture severely reduces mobility and
increases the risk of lung infections and blood clots, Ezekowitz said.
To make this worse, some patients with heart failure arent candidates
for surgical intervention because of the underlying heart disease.
Further study is needed to determine the mechanism
linking heart failure and fractures, he said. Until then, heart failure
patients should be screened for osteoporosis and treated if necessary.
Co-authors are: Sean van Diepen, M.D.; Sumit R.
Majumdar, M.D., M.P.H.; Jeffrey A. Bakal, Ph.D.; and Finlay A.
McAlister, M.D. Individual author disclosures can be found on the
manuscript.
Randomized Controlled Trials program of the
Canadian Institutes of Health Research funded the study.
Oct. 24, 2008 - Heart failure patients are at
higher risk for fractures, including debilitating hip fractures, than
other heart patients and should be screened and treated for
osteoporosis, Canadian researchers report in Circulation: Journal of
the American Heart Association. The average age of the heart failure
patients in the study was 78.
