Abstract 3767: Bone Mineral Density and Bone Loss over Time in Men with Chronic Heart Failure, and their Determinants
Background: Bone metabolism has not been comprehensively studied in chronic heart failure (CHF). We evaluated the prevalence of reduced BMD (bone mineral density), BMC (bone mineral content) and bone loss over time in CHF men, and assessed their determinants.
Methods: BMC and BMD in arms, legs, trunk and total body were measured using DEXA in 187 consecutive CHF men (age: 60±11 y [mean±SD], LVEF: 32±7 %, NYHA I/II/III/IV: 20/76/76/15).
Results: In men with CHF, reduced BMD and BMC in all anatomical regions were detected mainly in NYHA IV patients (NYHA I/II/III/IV: BMD-total: 1.22±0.11/1.20±0.07/1.19±0.09/1.12±0.11 g/cm2, BMC-total: 3.1±0.5/3.0±0.3/2.9±0.4/2.6±0.5 kg, respectively, p<0.05 - NYHA IV vs I-III). Densitometry bone parameters correlated positively to serum TT (total testosterone), serum dehydroepiandros-terone sulphate, LVEF, peak oxygen consumption, and inversely to serum parathormone (PTH), serum cross-linked beta-isomerised type I collagen C-terminal telepeptide fragments (bone resorption marker) (all p<0.05), but not to age, CHF aetiology, serum osteocalcin (bone formation marker) (all p>0.2). Reduced BMC and BMD were accompanied by diminished lean and fat tissue mass (p<0.001). Prevalence of osteopaenia (−2.5<T-score<-1.0) or osteoporosis (T-score=<−2.5) increased with CHF severity, being present in 20/17/30/47 % of men in NYHA I/II//III/IV. Bone status was reassessed in 60 CHF men who survived >2 y (mean time between 2 DEXA scans: 3±1 y). Significant bone loss over time (defined prospectively as a reduction in BMC-total >=1 %/y) occurred in 21 (35 %) CHF men (24/55 % of men in NYHA I-II/III-IV, p<0.05). Only baseline higher NYHA class (change in BMC-total: −0.2±1.3 vs −1.3±1.6 %/y, NYHA I-II vs III-IV, p=0.003), reduced TT (r=0.60, p=0.001) and high PTH (r=−0.51, p=0.01) predicted greater bone loss.
Conclusions: In men with CHF, reduced bone mass in mainly confined to the sickest patients, and is associated with fat and lean tissue wasting, hyperparathyroidism, enhanced bone resorption, and adrenal and gonadal anabolic deficiency. During a natural history of disease, a significant bone loss occurs in 1/3 of men with CHF, and is related predominantly to testosterone depletion, disease severity and hyperparathyroidism.