Washington, Oct 21 : Heart failure patients are at an increased risk of fractures, which includes debilitating hip fractures, according to a group of researchers.
Canadian researchers have reported in Circulation: Journal of the American Heart Association that heart failure patients are at higher risk for fractures than other heart patients and should be screened and treated for osteoporosis.
The study found that one year after an emergency room visit, 4.6 percent of heart failure patients experienced a fracture compared to only 1 percent of other heart patients. The one-year rate for hip fractures was 1.3 percent for heart failure patients compared to only 0.1 percent for other heart patients.
After researchers adjusted for other risk factors, heart failure patients had four times the risk of fracture and 6.3 times the risk of hip fracture as patients with heart attacks, chest pain or rhythm disturbances.
"This is the first study to link heart failure patients to a higher risk of fractures," said Justin A. Ezekowitz, M.D., senior author of the study and director of the Heart Function Clinic and assistant professor of medicine at the University of Alberta in Canada.
Heart failure and osteoporosis share common risk factors such as older age, female sex, smoking and type-2 diabetes.
The study included 16,294 patients with heart disease presenting at emergency rooms in Alberta, Canada from 1998 to 2001. Slightly more than 2,000 patients, average age 78, presented with a new diagnosis of heart failure.
The primary outcome was fracture requiring hospital admission at one year follow-up that was not due to trauma or other disease.
Researchers excluded patients with hospitalization for heart failure two years prior to the ER visit and patients with conditions known to modify fracture or fall risk.
Researchers ascertained prescription medication use based on database claims 60 days prior to and 60 days after the emergency room visit. The use of bisphosphonates and other osteoporosis medications was higher in the non-heart failure control group. But even when researchers excluded these patients, the risk of fracture was of similar magnitude.
Even after adjusting for medications known to affect the bones, dosages and co-morbidities, heart failure patients had a fourfold higher risk of fracture, Ezekowitz said. he reasons for this remain unclear, Ezekowitz said.
"It may be that heart failure patients aren't getting enough calcium or vitamin D," the expert added.