Heart Failure and Bone Loss: Are They Connected?

By its name alone, it’s obvious that heart failure is a serious condition. According to the Centers for Disease Control and Prevention (CDC), people living with this condition face a grim outlook, with roughly half dying within five years of diagnosis. While a failing heart frequently has dire consequences for the circulatory system, it may also render our bones more susceptible to damage.

An Unaddressed Problem

A 2011 Canadian study concluded that, among older adults suffering from heart failure, cases of osteoporosis were frequently left both untreated and undiagnosed. Authored by a team from the University of Alberta, this report examined X-rays of 623 adults, all of whom had been previously found to have heart failure. The demographics of this group skewed older and male; nearly 70 percent of those studied were men, and the subjects’ average age was 69.

Spinal fractures were a relatively common occurrence for the study’s participants. Chest X-rays revealed the presence of  moderate to severe vertebral fractures in 12 percent of the adults. Of these subjects, over half (55 percent) had multiple fractures in their spines.

Such injuries are a key indicator of osteoporosis, a condition in which bones steadily lose mass and grow weaker, leaving them vulnerable to fracture. Though they faced a greater threat of serious bone damage, 85 percent of subjects with bone fractures were not receiving osteoporosis treatment.

Heart Rhythms and Adrenal Hormones

The study also noted that the beating patterns of the heart may influence the health of the spine. Specifically, spinal fractures were twice as prevalent in participants with atrial fibrillation. This type of irregular heart beat is estimated to affect more than 2 million Americans, making it the most common condition of its type in the United States. The authors established this possible relationship after taking other risk factors for osteoporosis into consideration.

A hormone secreted by the adrenal glands might explain how atrial fibrillation, osteoporosis and heart failure may be connected. Known as aldosterone, this chemical substance is used by the body to keep its blood pressure under control. It also helps to the kidneys to maintain a proper balance of salt and water.

Though it plays an important role within the body, the authors contend that excessive amounts of aldosterone might have an adverse effect on bone strength, and could also contribute to the development of atrial fibrillation. However, additional research is needed to confirm that high levels of aldosterone are to blame for these problems.

If future studies verify that such links exists, treatments that target this hormone could be beneficial to both the skeletal system and the heart. While acknowledging that “further study is needed,” study author Dr. Justin A. Ezekowitz stated that “ treatment with an aldosterone antagonist like spironolactone could lower the incidence of fractures and atrial fibrillation in these patients.”

Additional Evidence

Less than a year later, two of the three authors from the 2011 report contributed to another study on this topic. A significantly larger number of subjects were involved in this research, with more than 45,500 adults agreeing to have their bone density tested. Slightly more than four percent (1,841) of these individuals had recently been told that they had heart failure.  The report, once again released by the University of Alberta, appeared in April 2012 issue of the Journal of Clinical Endocrinology & Metabolism.

After initial measurements of their bone density levels were taken, the participants’ bone health was monitored for up to a decade by the authors. In order to remove factors that could muddle their findings, the authors accounted for the subjects’ ages, gender and body mass indexes. Other relevant information, such as the use of prescription medicines for heart failure and osteoporosis, was likewise documented.

The researchers’ efforts yielded more evidence that heart failure weakens bones. Over a follow-up period lasting for a median of five years, the authors found that adults living with heart failure were 30 percent likelier to suffer major fractures. Given how frequently subjects with poorly-functioning hearts broke their bones, the authors contend that future studies on this relationship could lead to significant medical advances.

Study author Dr. Sumit Majumdar praised his team’s work, stating that the report “demonstrates for the first time that heart failure and thinning of bones go hand in hand. Understanding the mechanism between heart failure and osteoporosis might lead to new treatments for both conditions.” In light of the study’s findings, Majumdar suggests that chest X-rays of heart failure victims should be thoroughly studied during osteoporosis screenings.