MedPageToday
Cardiovascular
Published: Jul 10, 2014
By Todd Neale, Senior Staff Writer, MedPage Today

Story Source

Action Points

• Note that this observational cohort study demonstrated an association between lower bone mineral density in the heel and incident heart failure.
• Be aware that calcaneal ultrasound is not the standard tool for diagnosing osteoporosis; DXA scanning or, increasingly, quantitative CT may provide more definitive evidence of the purported relationship.

Lower bone mineral density may add up to a greater risk of developing heart failure, an analysis of a prospective study suggested.

For every 1 standard deviation increase in bone mineral density measured in the heel, the risk of heart failure was lower by a relative 23% (HR 0.77, 95% CI 0.66-0.89), according to Roman Pfister, MD, of the Heart Center of the University of Cologne in Germany, and colleagues.

That association was stronger for cases of heart failure that were not preceded by a myocardial infarction (HR 0.75, 95% CI 0.63-0.89) compared with those following an MI (HR 0.82, 95% CI 0.62-1.09), they reported online in JACC: Heart Failure.

“This is of major clinical interest because osteoporosis and low bone density are common, particularly in the elderly, affecting approximately 52 million persons in the U.S., and screening for osteoporosis is recommended by the U.S. Preventive Services Task Force for all women 65 years of age or older and all younger women with a similar disease risk,” Pfister and colleagues wrote. “Hence, information on the presence of this risk factor will be available in a large part of the elderly population and might be used to select people for further diagnostics of cardiac dysfunction.”

In addition, they wrote, “This adds to existing evidence suggesting that both diseases share common mechanisms in pathogenesis, and further research is warranted to explore underlying biological processes to identify new therapeutic targets for preventive interventions.”

Recent studies have shown that heart failure and osteoporosis share certain risk factors and that patients with heart failure have an elevated risk of future osteoporosis and fractures. But there is little information on the possibility that osteoporosis is associated with the development of heart failure.

The researchers explored the issue using data from 13,666 outwardly healthy individuals ages 42 to 82 (average age 62) who were participating in the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Norfolk study in England. Bone mineral density was measured by quantitative ultrasound of the calcaneum.

During an average follow-up of 9.3 years, there were 380 incident cases of either fatal or nonfatal heart failure, with the risk of heart failure declining in patients with higher bone mineral density (P=0.002 for trend).

Compared with the lowest quartile of bone mineral density, the second, third, and top quartiles of bone mineral density were associated with hazard ratios of 0.40 (95% CI 0.27-0.59), 0.54 (95% CI 0.37-0.79), and 0.46 (95% CI 0.32-0.68), respectively, after adjustment for age, sex, smoking, alcohol consumption, physical activity, occupational/social class, education level, systolic blood pressure, diabetes, cholesterol concentration, and body mass index.

The rates of incident heart failure across increasing quartiles of bone mineral density (per 1,000 person-years) were 4.6, 2.2, 3.3, and 3.6.

The researchers indicated that the observed relationship was unlikely to be explained by reverse causality, by shared risk factors between osteoporosis and heart failure, or by mediation by coronary heart disease, and said that a plausible explanation was the existence of underlying biological processes contributing to both low bone mineral density and incident heart failure.

The next step would be to validate the findings in another large database, according toKenneth Lyles, MD, and Cathleen Colon-Emeric, MD, of Duke University and VA Medical Centers in Durham, N.C.

“If confirmed in other cohorts, understanding the common pathophysiologic mechanism(s) will be an interesting and potentially fruitful quest,” they wrote in an accompanying editorial.

“Because both heart failure and osteoporosis are two of the chronic illnesses at the top of the list of expensive healthcare conditions, we are intrigued by the potential for simple interventions that may significantly reduce the burden caused by these disorders,” they wrote.

The study authors acknowledged some limitations of their study, including the likelihood that less severe cases of heart failure were missed, the inability to use DEXA — the standard tool used in diagnosing osteoporosis — to measure bone mineral density, the lack of detail on the cause of heart failure, and the possibility of residual confounding.

From the American Heart Association:

• Heart Failure Is a Risk Factor for Orthopedic Fracture

Primary source: JACC: Heart Failure