Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE), Recife, Brazil.
Womens Health (Lond). 2022 Jan-Dec;18:17455057221135501. doi: 10.1177/17455057221135501.
Heart failure (HF) is a prevalent clinical syndrome that causes significant physical limitations. Osteoporosis is also an important cause of loss of functionality, and it mainly affects women. There are several reports linking HF and osteoporosis, and both share risk factors. Most of the data available so far point to bone fragility as a consequence of HF, and several mechanisms have been identified to explain this relationship. Among the proposed pathophysiological mechanisms are the hyperactivation of the renin-angiotensin-aldosterone system and the increase in parathyroid hormone, functional limitation, production of inflammatory mediators and the use of drugs for HF. The role of osteoprotegerin has gained attention owing to its cardiovascular and skeletal effects, its observed deficiency during the postmenopausal period along with its compensatory increases in HF and severe osteoporosis. The objective of this review was to perform a literature search for the main evidence on skeletal impairment in HF, with emphasis on women. As for epidemiological studies, we selected data from 3 meta-analyses and 20 individual observational studies, which together showed the interrelationship between the two clinical conditions in terms of both decreased bone density and increased fracture risk. In conclusion, HF and osteoporosis are interrelated conditions mediated by complex pathophysiological mechanisms which may be more relevant for postmenopausal women, considered to be a vulnerable population for both cardiovascular diseases and bone fragility.
心力衰竭（HF）是一种常见的临床综合征，会导致严重的身体受限。骨质疏松症也是导致功能丧失的重要原因，主要影响女性。有几项报告将 HF 和骨质疏松症联系起来，两者有共同的危险因素。到目前为止，大多数可用数据表明，骨脆弱是 HF 的后果，已经确定了几种机制来解释这种关系。在提出的病理生理机制中，肾素-血管紧张素-醛固酮系统的过度激活和甲状旁腺激素的增加、功能受限、炎症介质的产生以及 HF 和严重骨质疏松症患者使用药物等。由于其对心血管和骨骼的影响，以及在绝经后期间观察到的骨保护素缺乏及其在 HF 和严重骨质疏松症中的代偿性增加，因此其作用引起了关注。本综述的目的是对 HF 骨骼损伤的主要证据进行文献检索，重点关注女性。就流行病学研究而言，我们选择了来自 3 项荟萃分析和 20 项单独观察性研究的数据，这些研究共同表明了这两种临床情况在骨密度降低和骨折风险增加方面的相互关系。总之，HF 和骨质疏松症是由复杂的病理生理机制介导的相互关联的疾病，对于绝经后妇女可能更为相关，她们被认为是心血管疾病和骨脆弱的高危人群。
