High fracture risk seen in heart failure patients

People with heart failure have an elevated risk for bone fractures, particularly a broken hip, and doctors should be on the lookout in these patients for signs of osteoporosis, Canadian researchers said Monday.

Among 16,294 patients with heart disease in Alberta, those treated for heart failure were four times as likely to have a fracture in the next year as those with other types of heart disease, the researchers report in the journal Circulation.

The heart failure patients were six times as likely as the others to sustain a hip fracture, the researchers added.

It was the first study to indicate heart failure patients are at greater risk for bone-weakening osteoporosis, said Dr. Justin Ezekowitz, director of the Heart Function Clinic at the University of Alberta in Edmonton, who helped lead the research.

"This intersection is important because orthopedic fracture, especially hip fracture, is very debilitating. On top of a very debilitating disease such as heart failure, this is a very big problem," Ezekowitz said in a telephone interview.

In people with heart failure, the heart becomes too weak or stiff to pump enough blood to the rest of the body. It is a life-threatening ailment often caused by high blood pressure and coronary artery disease.

Several factors may account for the higher fracture risk in the heart failure patients compared with the others, who had been treated for heart attack, chest pain and other heart conditions.

Ezekowitz said heart failure patients may not be getting enough calcium or vitamin D, which helps the body absorb calcium and is considered important for bone health, and they may be more frail overall.

In addition, some drugs may raise the risk of fractures, including the diuretic furosemide, also called Lasix, Ezekowitz said. And heart failure itself can lower bone density and quality, he added.

The study was only designed to find a correlation between heart failure and bone weakness and does not furnish evidence that one causes the other.

The people in the study generally were in their mid-70s. A year after an emergency room visit for heart failure, 4.6 per cent sustained a fracture compared with 1 per cent of the other heart patients, the researchers said.

"From a clinical perspective, I think we can really turn around and immediately start making sure our patients are adequately screened for osteoporosis," Ezekowitz said.

"The second part is we should make sure that people are getting adequate nutrition appropriate to prevent osteoporosis or even treat osteoporosis."