Osteoporosis and congestive heart failure (CHF) in the elderly patient: double disease burden

Abstract

The present study aimed to evaluate the association between osteoporosis and CHF in elderly patients and to assess the effect of physical performance, vitamin D levels, inflammatory markers on this association. One hundred and twenty-six consecutive patients aged 65 years and above, with moderate to severe CHF who presented to our institution for CHF management and 54 age- and sex-matched controls were screened for osteoporosis. All patients were thoroughly interrogated for cause of CHF, medications, smoking, alcohol use, additional comorbidities and previous falls/fractures. A physical examination was performed to assess CHF severity and New York Heart Association (NYHA) class. Bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DXA) were performed at the lumbar spine (LS) and femoral neck (FN). Physical performance assessment included grip strength, 6-min walk, "Get up and Go Test", activities of daily living (ADL) and frailty assessment. Biochemical assessment included measurement of levels of serum calcium, phosphorus, 1,25-dihyroxycholecalciferol=1,25(OH)(2)D (vitamin D(3)) and tumor necrosis factor-alpha (TNF-alpha). The BMD-Z-scores were significantly lower in HF patients compared to the non-HF controls. Furthermore, there was an association between the ejection fraction (EF) and the BMD-Z-scores. HF patients were significantly more likely to have poor physical performance, a higher frailty composite score, higher TNF-alpha and lower 1,25(OH)(2)D levels. A significant association was found between EF and frailty score, p<0.001. The results suggest that there is an association between HF and lower BMD. The increased bone loss in conjunction with CHF is likely to increase fracture risk. Thus, strategies for optimal treatment of CHF and for optimizing vitamin D(3), calcium and physical activity to improve quality of life (QoL) in these patients who have double disease burden are critical in these individuals.