May 11, 2011

Osteoporosis in Heart Failure Patients

(Ivanhoe Newswire) -- One in 10 heart failure patients had compression fractures in the spine that could have been detected by a chest X-ray, but few are receiving treatment to help prevent such fractures.

Among 623 heart failure patients, researchers found that 12 percent had moderate to severe vertebral compression fractures and 55 percent of those had multiple fractures. These fractures are a sign of osteoporosis, a condition in which bones become less dense and have a high risk of breaking. Only 15 percent of the heart failure patients with spinal fractures were being treated for osteoporosis, despite having a higher risk for fractures.

"Osteoporosis is an infrequently recognized and undertreated comorbidity of heart failure," Kristin J. Lyons, M.D., C.M., lead author of the study and chief medical resident in the Department of Medicine at the University of Alberta in Edmonton, Canada, was quoted as saying. "Fortunately, the chest X-ray can be used as a case-finding tool to increase fracture identification."

"While reviewing chest X-rays to look at the heart and lungs, physicians also need to look carefully at the bones. If fractures are found, patients need to be treated with dietary modification, exercise and, if indicated, osteoporosis medications. Treatment can reduce future fractures by as much as 50 percent," A. Ezekowitz, M.D., senior author of the study and assistant professor at the Mazankowski Alberta Heart Institute in the University of Alberta in Edmonton, was quoted as saying.

"As the population ages, two of the most prevalent diseases are heart disease and osteoporosis," Ezekowitz said. "While hip fractures are the most devastating complication of osteoporosis, vertebral compression fractures are by far the most common. Unfortunately, 60 percent to70 percent of spinal fractures are initially asymptomatic, escaping clinical detection yet placing the patients at higher risk for another vertebral facture and subsequent hip fractures."

The researchers hypothesize that hyperaldosteronism (high levels of the hormone aldosterone) may provide a plausible explanation for the relationship between chronic heart failure, osteoporosis and atrial fibrillation. Aldosterone, a hormone made in the adrenal gland, helps regulate blood pressure, the balance of fluids and electrolytes.

The researchers are studying whether atrial fibrillation should be considered as a risk factor for fractures in heart failure patients.

SOURCE: American Heart Association journal Circulation: Heart Failure, May 9, 2011