Youn J-C, Lee S J, Lee H S, Oh J, Hong N, Park S, Lee S-H, Choi D, Rhee Y, Kang S-M
Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Osteoporos Int. 2015 Aug;26(8):2121-9. doi: 10.1007/s00198-015-3112-3. Epub 2015 May 12.
Heart failure is associated with increased risk of osteoporosis. We evaluated the prevalence and predictors of osteoporosis in hospitalized patients with ADHF using quantitative computed tomography. Osteoporosis and vertebral fracture are prevalent in patients with ADHF and exercise capacity independently predicts bone mass and femoral bone geometry.
Heart failure is associated with reduced bone mass and increased risk of osteoporotic fractures. However, the prevalence and predictors of osteoporosis in hospitalized patients with acute decompensated heart failure (ADHF) are not well understood.
Sixty-five patients (15 postmenopausal females and 50 males) with ADHF were prospectively and consecutively enrolled. After stabilization of heart failure symptoms, quantitative computed tomography for bone mineral density (BMD) and femoral geometry as well as biochemical, echocardiographic, and cardiopulmonary exercise tests were performed.
Fifteen postmenopausal female showed a high prevalence of osteoporosis (40%) and vertebral fracture (53%). Among 50 male patients, 12% had osteoporosis and 32% had osteopenia, while vertebral fracture was found in 12%. Lumbar volumetric BMD (vBMD) was significantly lower in ischemic patients than non-ischemic patients (107.9 ± 47.5 vs. 145.4 ± 40.9 mg/cm(3), p = 0.005) in male. Exercise capacity, indicated by peak oxygen consumption (VO2), was significantly associated with lumbar vBMD (r = 0.576, p < 0.001) and total hip areal BMD (aBMD) (r = 0.512, p = 0.001) and cortical thickness of the femur neck (r = 0.544, p = 0.001). When controlled for age, body mass index, N-terminal proBrain natriuretic protein (NT-proBNP), etiology of heart failure, hemoglobin, and thigh circumference, multivariate regression analysis revealed peak VO2 independently predicted lumbar vBMD (β = 0.448, p = 0.031), total hip aBMD (β = 0.547, p = 0.021), and cortical thickness of the femur neck (β = 0.590, p = 0.011).
In male patients with ADHF, osteoporosis and vertebral fracture are prevalent, and exercise capacity independently predicts bone mass and geometry. Given that heart failure patients with reduced exercise capacity carry a substantial increased risk of fracture, proper osteoporosis evaluation is important in these patients.
心力衰竭与骨质疏松症风险增加相关。我们使用定量计算机断层扫描评估急性失代偿性心力衰竭（ADHF）住院患者骨质疏松症的患病率及预测因素。骨质疏松症和椎体骨折在ADHF患者中很常见，运动能力可独立预测骨量和股骨骨几何形态。
心力衰竭与骨量减少及骨质疏松性骨折风险增加相关。然而，急性失代偿性心力衰竭（ADHF）住院患者骨质疏松症的患病率及预测因素尚不清楚。
前瞻性连续纳入65例ADHF患者（15例绝经后女性和50例男性）。在心力衰竭症状稳定后，进行骨密度（BMD）和股骨几何形态的定量计算机断层扫描以及生化、超声心动图和心肺运动试验。
15例绝经后女性骨质疏松症患病率高（40%），椎体骨折患病率为53%。50例男性患者中，12%患有骨质疏松症，32%患有骨量减少，12%发现椎体骨折。男性中，缺血性患者的腰椎体积骨密度（vBMD）显著低于非缺血性患者（107.9±47.5 vs. 145.4±40.9 mg/cm³，p = 0.005）。以峰值耗氧量（VO₂）表示的运动能力与腰椎vBMD（r = 0.576，p < 0.001）、全髋部面积骨密度（aBMD）（r = 0.512，p = 0.001）及股骨颈皮质厚度（r = 0.544，p = 0.001）显著相关。在控制年龄、体重指数、N末端脑钠肽前体（NT-proBNP）、心力衰竭病因、血红蛋白和大腿围度后，多因素回归分析显示峰值VO₂可独立预测腰椎vBMD（β = 0.448，p = 0.031）、全髋部aBMD（β = 0.547，p = 0.021）及股骨颈皮质厚度（β = 0.590，p = 0.011）。
在ADHF男性患者中，骨质疏松症和椎体骨折很常见，运动能力可独立预测骨量和几何形态。鉴于运动能力降低的心力衰竭患者骨折风险大幅增加，对这些患者进行适当的骨质疏松症评估很重要。
