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Association of Left Ventricular Function with Bone Mineral Density in Older Women: A Population-Based Study

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Abstract

Due to the increasing mortality and disability rates associated with hip and vertebral fractures in older age, research is currently focusing on “new” determinants of osteoporosis in elderly subjects. Most recently, low bone mineral density (BMD) has been repeatedly reported in patients with end-stage heart failure. We assessed the association, if any, of BMD with left ventricular ejection fraction (LVEF) in a general older population. We assessed the association of LVEF with T score, Z score, and stiffness index in all 312 subjects aged 75 and over living in Tuscania, Italy. Among women, LVEF was associated with T score (β = 0.02, 95% CI 0.01–0.05; P = 0.033), Z score (β = 0.02, 95% CI 0.01–0.04; P = 0.038), and stiffness index (β = 0.25, 95% CI 0.02–0.48; P = 0.036) in multivariable linear regression analysis, after adjusting for lifestyle habits, demographic variables, comorbid conditions, polypharmacy, and objective measurements. No significant associations were observed in men. In linear discriminant analysis, the LVEF cutoff level that best predicted osteoporosis was ≤49%. Left ventricular function is directly and independently associated with all of the ultrasonographic BMD parameters in older women. As left ventricular dysfunction, often asymptomatic, is a prevalent finding in older women, this association and its potential therapeutic implications should be assessed in dedicated studies.

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References

  1. Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018

    Article  PubMed  CAS  Google Scholar 

  2. Wilkins CH, Birge SJ (2005) Prevention of osteoporotic fractures in the elderly. Am J Med 118:1190–1195

    Article  PubMed  Google Scholar 

  3. Cooper C (1999) Epidemiology of osteoporosis. Osteoporos Int 9 Suppl 2:S2–S8

    Article  Google Scholar 

  4. McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD; Resource Utilization Among Congestive Heart Failure (REACH) Study (2002) Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 39:60–69

    Article  PubMed  Google Scholar 

  5. Jessup M, Brozena S (2003) Heart failure. N Engl J Med 348:2007–2018

    Article  PubMed  Google Scholar 

  6. O’Meara E, Clayton T, McEntegart MB, McMurray JJ, Pina IL, Granger CB, Ostergren J, Michelson EL, Solomon SD, Pocock S, Yusuf S, Swedberg K, Pfeffer MA; CHARM Investigators (2007) Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Circulation 115:3111–3120

    Article  PubMed  Google Scholar 

  7. Devereux RB, Roman MJ, Paranicas M, Lee ET, Welty TK, Fabsitz RR, Robbins D, Rhoades ER, Rodeheffer RJ, Cowan LD, Howard BV (2001) A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: the Strong Heart Study. Am Heart J 141:439–446

    Article  PubMed  CAS  Google Scholar 

  8. Gaddi A, Cicero AF, Wani FO, Dormi A, Pasquarelli V, D’Addato S (2001) The realization of a project aimed at reducing the plasmatic lipid level in a large Italian population improves the mean calcium daily intake: the Brisighella Study. Eur J Clin Nutr 55:97–106

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. Pahor M, Chrischilles EA, Guralnik JM, Brown SL, Wallace RB, Carbonin P (1994) Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol 10:405–411

    Article  PubMed  CAS  Google Scholar 

  11. PHS-HCFA (1980) International classification of diseases, 9th rev. Public Health Service-Health Care Financing Administration, Washington DC

    Google Scholar 

  12. Langton CM, Palmer SB, Porter RW (1984) The measurement of broadband ultrasonic attenuation in cancellous bone. Eng Med 13:89–91

    Article  PubMed  CAS  Google Scholar 

  13. Rossman P, Zagzebski J, Mesina C, Sorenson J, Mazess R (1989) Comparison of speed of sound and ultrasound attenuation in the os calcis to bone density of the radius, femur and lumbar spine. Clin Phys Physiol Meas 10:353–360

    Article  PubMed  CAS  Google Scholar 

  14. WHO Scientific Group on the Prevention and Management of Osteoporosis (2000) Prevention and management of osteoporosis: report of a WHO scientific group. WHO Technical Report Series 921. WHO Library, Geneva

    Google Scholar 

  15. Kanis JA, Glüer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 11:192–202

    Article  PubMed  CAS  Google Scholar 

  16. Schiller NB, Acquatella H, Ports TA, Drew D, Goerke J, Ringertz H, Silverman NH, Brundage B, Botvinick EH, Boswell R, Carlsson E, Parmley WW (1979) Left ventricular volume from paired biplane two-dimensional echocardiography. Circulation 60:547–555

    PubMed  CAS  Google Scholar 

  17. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Järvinen M (1999) Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 353:802–805

    Article  PubMed  CAS  Google Scholar 

  18. Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289

    Article  PubMed  CAS  Google Scholar 

  19. Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51:364–370

    Article  PubMed  Google Scholar 

  20. Schousboe JT, Taylor BC, Fink HA, Kane RL, Cummings SR, Orwoll ES, Melton LJ 3rd, Bauer DC, Ensrud KE (2007) Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 298:629–637

    Article  PubMed  CAS  Google Scholar 

  21. Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnée AR, Closon MC, Boonen S (2000) Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int 11:373–380

    Article  PubMed  CAS  Google Scholar 

  22. Shane E, Mancini D, Aaronson K, Silverberg SJ, Seibel MJ, Addesso V, McMahon DJ (1997) Bone mass, vitamin D deficiency, and hyperparathyroidism in congestive heart failure. Am J Med 103:197–207

    Article  PubMed  CAS  Google Scholar 

  23. Nayak S, Olkin I, Liu H, Grabe M, Gould MK, Allen IE, Owens DK, Bravata DM (2006) Meta-analysis: accuracy of quantitative ultrasound for identifying patients with osteoporosis. Ann Intern Med 144:832–841

    PubMed  Google Scholar 

  24. Lee AH, Mull RL, Keenan GF, Callegari PE, Dalinka MK, Eisen HJ, Mancini DM, DiSesa VJ, Attie MF (1994) Osteoporosis and bone morbidity in cardiac transplant recipients. Am J Med 96:35–41

    Article  PubMed  CAS  Google Scholar 

  25. Nishio K, Mukae S, Aoki S, Itoh S, Konno N, Ozawa K, Satoh R, Katagiri T (2003) Congestive heart failure is associated with the rate of bone loss. J Intern Med 253:439–446

    Article  PubMed  CAS  Google Scholar 

  26. Kado DM, Browner WS, Blackwell T, Gore R, Cummings SR (2000) Rate of bone loss is associated with mortality in older women: a prospective study. J Bone Miner Res 15:1974–1980

    Article  PubMed  CAS  Google Scholar 

  27. Mussolino ME, Madans JH, Gillum RF (2003) Bone mineral density and mortality in women and men: the NHANES I epidemiologic follow-up study. Ann Epidemiol 13:692–697

    Article  PubMed  Google Scholar 

  28. Trivedi DP, Khaw KT (2001) Bone mineral density at the hip predicts mortality in elderly men. Osteoporos Int 12:259–265

    Article  PubMed  CAS  Google Scholar 

  29. Farhat GN, Strotmeyer ES, Newman AB, Sutton-Tyrrell K, Bauer DC, Harris T, Johnson KC, Taaffe DR, Cauley JA (2006) Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int 79:102–111

    Article  PubMed  CAS  Google Scholar 

  30. Tankó LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920

    Article  PubMed  Google Scholar 

  31. Marcovitz PA, Tran HH, Franklin BA, O’Neill WW, Yerkey M, Boura J, Kleerekoper M, Dickinson CZ (2005) Usefulness of bone mineral density to predict significant coronary artery disease. Am J Cardio 96:1059–1063

    Article  Google Scholar 

  32. Farhat GN, Newman AB, Sutton-Tyrrell K, Matthews KA, Boudreau R, Schwartz AV, Harris T, Tylavsky F, Visser M, Cauley JA; Health ABC Study (2007) The association of bone mineral density measures with incident cardiovascular disease in older adults. Osteoporos Int 18:999–1008

    Article  PubMed  CAS  Google Scholar 

  33. Wieczorowska-Tobis K, Niemir ZI, Podkowka R, Korybalska K, Mossakowska M, Breborowicz A (2006) Can an increased level of circulating IL-8 be a predictor of human longevity? Med Sci Monit 12:CR118–CR121

    PubMed  CAS  Google Scholar 

  34. Petretta M, Condorelli GL, Spinelli L, Scopacasa F, de Caterina M, Leosco D, Vicario ML, Bonaduce D (2000) Circulating levels of cytokines and their site of production in patients with mild to severe chronic heart failure. Am Heart J 140:E28

    Article  PubMed  CAS  Google Scholar 

  35. Troen BR (2003) Molecular mechanisms underlying osteoclast formation and activation. Exp Gerontol 38:605–614

    Article  PubMed  CAS  Google Scholar 

  36. Lauretani F, Bandinelli S, Russo CR, Maggio M, Di Iorio A, Cherubini A, Maggio D, Ceda GP, Valenti G, Guralnik JM, Ferrucci L (2006) Correlates of bone quality in older persons. Bone 39:915–921

    Article  PubMed  CAS  Google Scholar 

  37. Fujimoto H, Fujimoto K, Ueda A, Ohata M (1999) Hypoxemia is a risk factor for bone mass loss. J Bone Miner Metab 17:211–216

    Article  PubMed  CAS  Google Scholar 

  38. Mineo TC, Ambrogi V, Mineo D, Fabbri A, Fabbrini E, Massoud R (2005) Bone mineral density improvement after lung volume reduction surgery for severe emphysema. Chest 127:1960–1966

    Article  PubMed  Google Scholar 

  39. Dimai HP, Domej W, Leb G, Lau KH (2001) Bone loss in patients with untreated chronic obstructive pulmonary disease is mediated by an increase in bone resorption associated with hypercapnia. J Bone Miner Res 16:2132–2141

    Article  PubMed  CAS  Google Scholar 

  40. Karadag F, Cildag O, Yurekli Y, Gurgey O (2003) Should COPD patients be routinely evaluated for bone mineral density? J Bone Miner Metab 21:242–246

    PubMed  Google Scholar 

  41. O’Meara E, Clayton T, McEntegart MB, McMurray JJ, Pina IL, Granger CB, Ostergren J, Michelson EL, Solomon SD, Pocock S, Yusuf S, Swedberg K, Pfeffer MA; CHARM Investigators (2007) Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Circulation 115:3111–3120

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was partially supported as a “targeted project” (SS9.4.2) by the Italian Ministry of Health.

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Correspondence to Alice Laudisio.

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Laudisio, A., Marzetti, E., Antonica, L. et al. Association of Left Ventricular Function with Bone Mineral Density in Older Women: A Population-Based Study. Calcif Tissue Int 82, 27–33 (2008). https://doi.org/10.1007/s00223-007-9094-1

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  • DOI: https://doi.org/10.1007/s00223-007-9094-1

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