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Femoral bone mineral density in patients with heart failure

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Abstract

Introduction

Heart failure and osteoporosis are common conditions in older, frail individuals. It is important to investigate interactions of the common problems in the aging population to devise relevant interventions.

Methods

Sixty individuals (43 men, mean age 77±9 years, and 17 women, mean age 78±12 years) with heart failure (HF) and 23 age- and gender-matched non-HF controls (15 men, eight women; mean age 77±9 years) underwent hip and bone mineral density (BMD) assessments; frailty assessment; physical performance assessment including 6-min walk, grip strength, and self-reported physical activity; and biochemical assessment including calcium, parathyroid hormone (PTH), 25-hydroxy vitamin D (25-OHD), estradiol, creatinine (Cr), and blood urea nitrogen levels (BUN).

Results

Significant differences between HF and control groups were found for BMD Z-scores of the femoral neck, total femur, and trochanteric region at the femur (p<.05). Further differences between groups included frailty score (p=.02), 6-min walking distance (p<.001), and self-reported physical activity (p=.001). In addition, several differences between groups were present for calcium (p=.054), PTH (p<.001), 25-OHD (p=.01), Cr (p=.04), and BUN (p=.01). In regression analysis, HF (defined as case, by ejection fraction, or by New York Heart Association class), frailty status, and vitamin D were significant predictors of lower bone mass at the femur.

Conclusions

Individuals with HF have lower BMD, in part related to lower vitamin D status and higher frailty rates. Interventions to optimize vitamin D and physical activity should be explored to prevent bone loss in individuals with heart failure.

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References

  1. Newman AB, Gottdiener JS, McBernie MA, Hirsch CH, Kop WJ, Tracy RP, Walston JD, Fried LP (2001) Associations of subclinical cardiovascular disease with frailty. J Gerontol 56A(3):M158–M166

    Google Scholar 

  2. Walston JD, McBernie MA, Newman AB, Tracy RP, Kop WJ, Hirsch CH, Gottdiener JS, Fried LP (2002) Frailty and activation of the inflammation and coagulation systems with and without co-morbidities. Arch Intern Med 162:2333–2341

    Article  PubMed  Google Scholar 

  3. Kenny AM, Waynik IV, Smith J, Fortinsky R, Kleppinger A, McGee D. Association between osteoporosis and frailty in older community dwelling men. (Unpublished work)

  4. Hunt SA, Baker DW, Chin MH, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure); International Society for Heart and Lung Transplantation; Heart Failure Society of America (2001) ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. Circulation 104(24):2996–3007

    Google Scholar 

  5. Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB et al (2002) Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation 106(24):3068–3072

    Article  PubMed  Google Scholar 

  6. Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ (2004) Trends in heart failure incidence and survival in a community-based population. JAMA 292(3):344–350

    Article  PubMed  CAS  Google Scholar 

  7. Ray NF, Chann JK, Thamer M, Melton LJ (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35

    Article  PubMed  CAS  Google Scholar 

  8. Shane E, Mancini D, Aaronson K et al (1997) Bone mass, vitamin D deficiency, and hyperparathyroidism in congestive heart failure. Am J Med 103(3):197–207

    Article  PubMed  CAS  Google Scholar 

  9. Shane E, Rivas M, McMahon DJ, Staron RB, Silverberg SJ, Seibel MJ, Mancini D, Michler RE, Aaronson K, Addesso V, Lo SH (1997) Bone loss and turnover after cardiac transplantation. J Clin Endocrinol Metab 82(5):1497–1506

    Article  PubMed  CAS  Google Scholar 

  10. Muchmore JS, Cooper DK, Ye Y, Schlegel V, Pribil A, Zuhdi N (1992) Prevention of loss of vertebral bone density in heart transplant patients. J Heart Lung Transplant 11(5):959–963

    PubMed  CAS  Google Scholar 

  11. Lee AH, Mull RL, Keenan GF, et al (1994) Osteoporosis and bone morbidity in cardiac transplant recipients. Am J Med 96(1):35–41

    Article  PubMed  CAS  Google Scholar 

  12. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol 56A(3):M146–M156

    Google Scholar 

  13. Orme JG, Reis J, Herz EJ (1986) Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale. J Clin Psychol 42(1):28–33

    Article  PubMed  CAS  Google Scholar 

  14. Washburn RA, Smith KW, Jette AM, Janney CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46(2):153–162

    Article  PubMed  CAS  Google Scholar 

  15. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132(8):919–923

    PubMed  CAS  Google Scholar 

  16. Anker SD, Clark AL, Teixeira MM, Hellewell PG, Coats AJ (1999) Loss of bone mineral in patients with cachexia due to chronic heart failure. Am J Cardiol 83(4):612–615, A10

    Article  PubMed  CAS  Google Scholar 

  17. World Health Organization (1994) WHO technical report series #843: assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organization, Geneva

  18. Orwoll E (2000) Assessing bone density in men. J Bone Miner Res 15(10):1867–1870

    Article  PubMed  CAS  Google Scholar 

  19. Amin S, Feldson DT (2001) Osteoporosis in men. Rheum Dis Clin North Am 27:19–47

    Article  PubMed  CAS  Google Scholar 

  20. Gerdhem P, Ringsberg KA, Magnusson H, Obrant KJ, Akesson K (2003) Bone mass cannot be predicted by estimations of frailty in elderly ambulatory women. Gerontology 3:168–172

    Article  Google Scholar 

  21. Kenny AM, Waynik IY, Smith JA, Fortinksy R, Kleppinger A, McGee D. The association between level of frailty and bone mineral density in community-dwelling men. (Submitted for publication)

  22. Gleeson PB, Protas EJ, LeBlanc AD, Schneider VS, Evans HJ (1990) Effects of weight lifting on bone mineral density in premenopausal women. J Bone Miner Res 5(2):153–158

    PubMed  CAS  Google Scholar 

  23. Snow-Harter C, Bouxsein ML, Lewis BT, Carter DR, Marcus R (1992) Effects of resistance and endurance exercise on bone mineral status of young women: a randomized exercise intervention trial. J Bone Miner Res 7(7):761–769

    Article  PubMed  CAS  Google Scholar 

  24. Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ (1994) Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 272(24):1909–1914

    Article  PubMed  CAS  Google Scholar 

  25. Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ Jr (1988) Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 108(6):824–828

    PubMed  CAS  Google Scholar 

  26. Judge JO, Kleppinger A, Kenny A, Smith JA, Biskup B, Marcella G (2005) Home-based resistance training improves femoral bone mineral density in women on hormone therapy. Osteoporos Int 16(9):1096–1108

    Google Scholar 

  27. Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, Fletcher BJ, Fleg JL, Myers JN, Sullivan MJ (2003) Exercise and heart failure: a statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation 107:1210–1225

    Article  PubMed  Google Scholar 

  28. HF-Action: http://www.clinicaltrials.gov/ct/show/NCT00047437

  29. Reichel H, Koeffler HP, Norman AW (1989) The role of the vitamin D endocrine system in health and disease. New Eng J Med 320:980–991

    Article  PubMed  CAS  Google Scholar 

  30. Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C (2000) Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 15:1113–1118

    Article  PubMed  CAS  Google Scholar 

  31. Bischoff HA, Staehelin HB, Dick W, Akos R, Theiler R, Pfeiffer M, Begerow B, Lew RA, Conzelmann M (2001) Fall prevention by vitamin D and calcium supplementation. J Bone Min Res 16(supp1):S163

    Google Scholar 

  32. Young A, Brenton DP, Edwards R (1978) Analysis of muscle weakness in osteomalacia. Clin Sci Mol Med 54(2):31

    Google Scholar 

  33. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B (2004) Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged >or =60 y. Am J Clin Nutr 80(3):752–758

    PubMed  CAS  Google Scholar 

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Acknowledgements

This work was supported by the General Clinical Research Center (MO1-RR06192) and R01 AG18887. We wish to thank Linda Gregory, Alison Kleppinger, and MaryBeth Barry for their help in completing this work.

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Authors and Affiliations

  1. Center on Aging, MC-5215, University of Connecticut Health Center, Farmington, CT, 06030-5215, USA

    A. M. Kenny

  2. Case Western University Hospital, Cleveland, OH(RB), USA

    R. Boxer

  3. Center on Biostatistics, University of Connecticut Health Center, Farmington, CT, 06030-5215, USA

    S. Walsh

  4. Division of Cardiology, University of Connecticut Health Center, Farmington, CT, 06030-5215, USA

    W. D. Hager

  5. Division of Musculoskeletal Health, University of Connecticut Health Center, Farmington, CT, 06030-5215, USA

    L. G. Raisz

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  1. A. M. Kenny
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Correspondence to A. M. Kenny.

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Kenny, A.M., Boxer, R., Walsh, S. et al. Femoral bone mineral density in patients with heart failure. Osteoporos Int 17, 1420–1427 (2006). https://doi.org/10.1007/s00198-006-0148-4

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  • DOI: https://doi.org/10.1007/s00198-006-0148-4

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