These two authors contributed equally to this work.
Bone mass loss in chronic heart failure is associated with secondary hyperparathyroidism and has prognostic significance
Article first published online: 18 FEB 2014
Published on behalf of the European Society of Cardiology. All rights reserved. © 2012 the Authors
European Journal of Heart Failure
Volume 14, Issue 3, pages 326–332, March 2012
How to Cite
Terrovitis, J., Zotos, P., Kaldara, E., Diakos, N., Tseliou, E., Vakrou, S., Kapelios, C., Chalazonitis, A., Nanas, S., Toumanidis, S., Kontoyannis, D., Karga, E. and Nanas, J. (2012), Bone mass loss in chronic heart failure is associated with secondary hyperparathyroidism and has prognostic significance. European Journal of Heart Failure, 14: 326–332. doi: 10.1093/eurjhf/hfs002
- Issue published online: 18 FEB 2014
- Article first published online: 18 FEB 2014
- Manuscript Accepted: 23 DEC 2011
- Manuscript Revised: 16 DEC 2011
- Manuscript Received: 6 SEP 2011
- heart failure;
- bone mineral density;
- vitamin D;
Chronic heart failure (CHF) is associated with increased risk of osteoporosis. We investigated the relationship between severity of CHF and bone loss, underlying pathophysiological mechanisms, and the prognostic significance of bone mass changes in heart failure.
Methods and results
Total body (TB) and femoral (F) bone mineral density (BMD), and T- and Z-scores in the femur were measured in 60 men with CHF (56 ± 11 years) and 13 age-matched men free from CHF. The composite study endpoint was death, implantation of a left ventricular assist device (LVAD), or inotrope dependency during a median 2-year follow-up. Parathyroid hormone (PTH) and vitamin D were measured in all subjects. TBBMD, FBMD, T-score, and Z-score were significantly lower in men with CHF. Their PTH levels were also significantly increased (111 ± 59 vs. 39 ± 14; P < 0.001). Patients in New York Heart Association classes III–IV compared with those in classes I–II demonstrated significantly lower TBBMD, FBMD, T-score, and Z-score, and higher PTH (136 ± 69 vs. 86 ± 31; P= 0.001). Increased PTH levels were correlated with reduced TBBMD (P = 0.003), FBMD (P = 0.002), and femur T-score (P = 0.001), reduced cardiac index (P = 0.01) and VO2 peak (P < 0.0001), and increased wedge pressure (P = 0.001). Low TBBMD [hazard ratio (HR) 0.003, 95% confidence interval (CI) 0.00–0.58; P = 0.03] and Z-score (HR 0.56, 95% CI 0.35–0.90; P = 0.017) were associated with adverse outcome.
Secondary hyperparathyroidism and reduction in bone density occur in CHF patients and are associated with disease severity. Increased bone mass loss in CHF has prognostic significance.