Heart Failure as a Risk Factor for Osteoporosis and Fractures

Abstract

Although heart failure (HF) and osteoporosis are common diseases, particularly in elderly populations, patients with HF have an increased risk for osteoporosis. The relationship of HF with osteoporosis is modified by gender and the severity of HF. In addition, shared risk factors, medication use, and common pathogenic mechanisms affect both HF and osteoporosis. Shared risk factors for these 2 conditions include advanced age, hypovitaminosis D, renal disease, and diabetes mellitus. Medications used to treat HF, including spironolactone, thiazide diuretics, nitric oxide donors, and aspirin, may protect against osteoporosis. In contrast, loop diuretics may make osteoporosis worse. HF and osteoporosis appear to share common pathogenic mechanisms, including activation of the renin-angiotensin-aldosterone system, increased parathyroid hormone levels, and/or oxidative/nitrosative stress. HF is a major risk factor for mortality following fractures. Thus, in HF patients, it is important to carefully assess osteoporosis and take measures to reduce the risk of osteoporotic fractures.

Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in a Large US Health System Population

“…For example, inconsistent with recent literature (23,24), our models suggest that heart failure is modestly associated with a decreased odds of osteoporosis and fragility fracture. Inconsistent with other literature, odds ratios for osteoporosis associated with use of estrogens and Ts are greater than 1 in the present study.…”

Tea and flavonoid intake predict osteoporotic fracture risk in elderly Australian women: a prospective study

“…For example, tea and flavonoid intakes have been convincingly linked to vascular health (37). Cardiovascular disease is a known risk factor for fracture (38,39). It is possible that beneficial effects of tea and flavonoids on vascular health may be important mediators in fracture risk.…”

Bone mineral density and osteoporosis in heart transplanted patients: A single‐center retrospective study at Skåne University Hospital in Lund 1988‐2016

“…A common side effect of immunosuppressive therapies is osteoporosis, which is characterized as a skeletal disorder with impaired bone strength, measured in bone mineral density (BMD), and increased risk of bone fractures . Osteoporosis may also be a consequence of various factors that are associated with the heart failure itself prior to HT, such as immobilization, impaired renal function, nutritional deficiency, as well as heart failure medications . Not only does osteoporosis cause increased morbidity, but it is also associated with increased mortality rates …”