Heart failure ups fracture risk in meta-analysis

  • Osteoporos Int

  • International Clinical Digest
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Takeaway

  • A meta-analysis finds that heart failure may increase the risk of osteoporotic fracture, especially of the hip and humerus.

Why this matters

  • The biological basis for increased risk may trace to (1) common risk factors, such as aging, menopause, smoking, and diabetes mellitus; and (2) some heart failure medications may trigger bone loss.
  • Findings suggest that heart failure patients should be screened and treated for osteoporosis.

Study design

  • Meta-analysis of 7 cohort studies involving approximately 180,000 participants, after search of PubMed, EMBASE, and Cochrane.
  • Funding: None disclosed.

Key results

  • Included studies were rated of high quality by the Newcastle-Ottawa Scale.
  • Heart failure is associated with a 66% increased risk of fracture of any type (risk ratio [RR], 1.66; I2=94%; P=.008).
    • Heart failure is associated with more than 3 times the risk of hip fracture (RR, 3.45; I2=95%; P<.0001>
    • Heart failure is associated with a 91% increased risk of humerus fracture (RR, 1.91; I2=39%; P=.03).
    • Heart failure is not associated with increased risk of vertebral (P=.11) and forearm (P=.69) fractures.

Limitations

  • High heterogeneity across studies.
  • Small number of cohorts.