van Diepen Sean, Majumdar Sumit R, Bakal Jeffrey A, McAlister Finlay A, Ezekowitz Justin A
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Circulation. 2008 Nov 4;118(19):1946-52. doi: 10.1161/CIRCULATIONAHA.108.784009. Epub 2008 Oct 20.
Heart failure (HF) is associated with factors that may contribute to accelerated bone loss and subsequent fractures. Whether it leads to an increased fracture risk is unknown.
A population-based cohort of consecutive patients >/=65 years of age with cardiovascular disease presenting to all emergency rooms between 1998 and 2001 in Alberta, Canada (n=16294 patients), was used. The 2041 patients with a new diagnosis of HF were compared with a control group of 14 253 patients with non-HF cardiovascular diagnoses. The primary outcome was any orthopedic fracture requiring hospital admission in the year after the emergency room visit. Patients with HF had a median age of 78 years (interquartile range, 72 to 84 years), and 51.9% were female; control subjects had a median age of 73 years (interquartile range, 68 to 79 years), and 53.2% were female. In the first year after the emergency room visit, 4.6% of the HF cohort (n=93) and 1.0% of patients without HF (n=147) sustained an orthopedic fracture (P<0.001). Hip fractures occurred in 26 HF patients (1.3%) and 18 patients (0.1%) without HF (P<0.001). After multivariable adjustment, HF was independently associated with a greater risk of any orthopedic fracture (adjusted odds ratio, 4.0; 95% CI, 2.9 to 5.3) or hip fracture (adjusted odds ratio, 6.3; 95% CI, 3.4 to 11.8).
HF is associated with an increased risk of subsequent orthopedic fracture, particularly hip fracture. This suggests that screening for and treatment of osteoporosis to reduce fracture risk need to be considered in those with HF.
心力衰竭（HF）与可能导致骨质加速流失及随后骨折的因素相关。其是否会导致骨折风险增加尚不清楚。
采用了加拿大艾伯塔省1998年至2001年间所有急诊室收治的年龄≥65岁的连续心血管疾病患者的基于人群的队列（n = 16294例患者）。将2041例新诊断为HF的患者与14253例非HF心血管疾病诊断的对照组患者进行比较。主要结局是急诊室就诊后一年内需要住院治疗的任何骨科骨折。HF患者的中位年龄为78岁（四分位间距，72至84岁），51.9%为女性；对照组患者的中位年龄为73岁（四分位间距，68至79岁），53.2%为女性。在急诊室就诊后的第一年，HF队列中的4.6%（n = 93）和无HF患者中的1.0%（n = 147）发生了骨科骨折（P < 0.001）。26例HF患者（1.3%）和18例无HF患者（0.1%）发生了髋部骨折（P < 0.001）。多变量调整后，HF与任何骨科骨折（调整后的优势比，4.0；95%置信区间，2.9至5.3）或髋部骨折（调整后的优势比，6.3；95%置信区间，3.4至11.8）的风险增加独立相关。
HF与随后发生骨科骨折尤其是髋部骨折的风险增加相关。这表明对于HF患者需要考虑进行骨质疏松症的筛查和治疗以降低骨折风险。
