Heart failure patients’ osteoporosis often undiagnosed, untreated

One in 10 heart failure patients had compression fractures in the spine that could have been detected by a chest X-ray, but few are receiving treatment to help prevent such fractures according to a Canadian study published in the American Heart Association journal Circulation: Heart Failure.

Among 623 heart failure patients, researchers found that 12 percent had moderate to severe vertebral compression fractures and 55 percent of those had multiple fractures. These fractures are a sign of osteoporosis, a condition in which bones become less dense and have a high risk of breaking. Only 15 percent of the heart failure patients with spinal fractures were being treated for osteoporosis, despite having a higher risk for fractures.

After adjusting for other risk factors for osteoporosis, heart failure patients who also had atrial fibrillation were twice as likely to have vertebral fractures as those with normal heart rhythms.

“Osteoporosis is an infrequently recognized and undertreated comorbidity of heart failure,” said Kristin J. Lyons, M.D., C.M., lead author of the study and chief medical resident in the Department of Medicine at the University of Alberta in Edmonton, Canada. “Fortunately, the chest X-ray can be used as a case-finding tool to increase fracture identification.”

Physicians’ attention to the chest X-ray findings of their heart failure patients are key, said Justin A. Ezekowitz, M.D., senior author of the study and assistant professor at the Mazankowski Alberta Heart Institute in the University of Alberta in Edmonton. “While reviewing chest X-rays to look at the heart and lungs, physicians also need to look carefully at the bones. If fractures are found, patients need to be treated with dietary modification, exercise and, if indicated, osteoporosis medications. Treatment can reduce future fractures by as much as 50 percent.”

Participants in the study were average age 69, 32 percent were 75 years or older and 31 percent were women. Average left ventricular ejection fraction was 32 percent in about half, 38 percent had atrial fibrillation and 65 percent had ischemic cardiomyopathy.

Heart failure patients with spinal fractures were older, more likely to be female, weighed less and more likely to have atrial fibrillation, the researchers found.

“As the population ages, two of the most prevalent diseases are heart disease and osteoporosis,” Ezekowitz said. “While hip fractures are the most devastating complication of osteoporosis, vertebral compression fractures are by far the most common. Unfortunately, 60 percent to70 percent of spinal fractures are initially asymptomatic, escaping clinical detection yet placing the patients at higher risk for another vertebral facture and subsequent hip fractures.”

Researchers found a higher incidence of fractures than in previous studies because many of the spinal fractures were asymptomatic and undiagnosed, he said.