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Laura J. Martin, MD
May 10, 2011 -- New research suggests that up to 12% of people with heart failure may have osteoporosis as well as spine compression fractures that often are characteristic of the bone disease.
What is more, the osteoporosis in most cases probably could be detected with a simple chest X-ray, leading to treatment to prevent fractures, according to a new study.
The study is published in the journal Circulation: Heart Failure, a publication of the American Heart Association.
The researchers studied 623 heart failure patients and found that 12% had moderate to severe vertebral compression fractures; 55% of those people had multiple fractures.
Fractures such as these can be a sign of osteoporosis, a disease in which the bones become less dense and more fragile. People with osteoporosis have an increased risk of bone fracture especially of the hip, spine, and wrist.
Patients in the study had a median age of 69, 32% were 75 or older, and 31% were women; 38% of the participants had atrial fibrillation, a type of irregular heartbeat.
The researchers say only 15% of the heart failure patients with spine fractures were being treated for osteoporosis, despite the well-known risk of osteoporosis-related fractures.
The researchers also say that heart failure patients with atrial fibrillation were twice as likely to have spine fractures as people with normal heart rhythms.
"Osteoporosis is an infrequently recognized and undertreated co-morbidity of [occurring with] heart failure,” Kristin J. Lyons, MD, CM, of the University of Alberta in Edmonton, Canada, says in a news release. “Fortunately the chest X-ray can be used as a case-finding tool to increase fracture identification.”
It is important that doctors pay attention to the chest X-ray findings of their heart failure patients so that treatment can be started, says study researcher Justin A. Ezekowitz, MD. Ezekowitz is an assistant professor at the Mazankowski Alberta Heart Institute in Edmonton, Canada.
He says doctors, while examining chest X-rays to look for heart and lung problems, “need to look carefully at the bones” of patients.
“If fractures are found, patients need to be treated with dietary modification, exercise and, if indicated, osteoporosis medications,” he says in the news release. “Treatment can reduce future fractures by as much as 50%.”
While hip fractures are the most devastating complication of osteoporosis, spine compression fractures are by far the most common, Ezekowitz says.
Yet 60% to 70% of spine fractures are, at first, asymptomatic, meaning there are no symptoms, and thus are easy to escape detection. Some spine fractures can lead to chronic pain and disability.
High levels of the hormone aldosterone may provide a reasonable explanation for the relationship between chronic heart failure, osteoporosis, and atrial fibrillation, the researchers speculate. Aldosterone is a hormone made in the adrenal gland that helps regulate blood pressure, the balance of fluids, and electrolytes.
Ezekowitz speculates that treatment with a diuretic drug, such as spironolactone, which is also used to treat high blood pressure, could lower the incidence of fractures in people with osteoporosis.
Further study is needed to confirm or refute this hypothesis, he says.
SOURCES:News release, American Heart Association.Ezekowitz, J. Circulation: Heart Failure, May 10, 2011.
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