Abstract 13703: Osteoporosis in Heart Failure is Associated with Secondary Hyperparathyroidism and has Adverse Prognostic Implications
Background: Chronic heart failure (CHF) has been recently associated with osteoporosis. The relationship between severity of CHF and bone mass loss and the underlying pathophysiologic mechanisms have not been thoroughly investigated.
Methods: Bone mineral density (BMD) of total body (TB) was examined using dual energy X-ray absorptiometry (DEXA) in 60 male patients with CHF (age: 56 ± 11) and in 13 age-matched male patients without CHF. BMD, T-score and Z-score were also measured in femur (F). Parathyroid hormone (PTH) levels and vitamin D were measured in all subjects.
Results: Men with CHF had significantly reduced TB BMD and F BMD, T- and Z-scores compared with controls (p: 0.001, p: 0.004, p: 0.007, p: 0.003 respectively). They also had increased PTH levels (p: <0.001). Patients in higher NYHA class (III, IV) compared with those in lower NYHA class (I, II) demonstrated significantly lower TBBMD (1.183±0.092 vs. 1.245±0.070; p:0.004) and FBMD (0.819±0.137 vs. 0.925±0.140; p:0.008), lower T-score (−1.9±1.1 vs. -1.1±1.1; p:0.005) and Z-score (−1.1±0.9 vs. -0.3±1.1; p:0.02) in femur and higher PTH levels (136±69 vs. 86±31; p:0.001). Vitamin D levels were also reduced, but not statistically significant (p:0.07). Increased PTH levels were independently associated with reduced TBBMD (r=0.34, p:0.003) and FBMD (r=0.38, p:0.002), reduced cardiac index (r=0.35, p:0.01), increased wedge pressure (r=0.38, p:0.005) and reduced VO2 peak (r=0.47, p:<0.001). Finally, during 2 years follow-up, 11 patients died, in 3 patients LVAD was implanted and 5 patients required intermittent inotrope infusion. Cox regression analysis revealed that higher TBBMD (95% CI, 0.00 to 0.58, p:0.03) and femoral Z-score (95% CI, 0.35 to 0.90, p:0.02) were associated with significantly reduced risk for morbidity and mortality.
Conclusions: CHF is associated with increased bone mass loss and secondary hyperparathyroidism, a well known predisposing factor of osteoporosis. Increased bone mass loss in CHF patients has prognostic significance. Hyperparathyroidism and reduction in bone density are associated with CHF severity. Secondary hyperparathyroidism may be the underlying pathophysiologic mechanism of osteoporosis in CHF.
- © 2010 by American Heart Association, Inc.