Vertebral Fractures in Patients with Heart Failure

A vertebral compression fracture is usually caused by osteoporosis, and is characterized by a sudden sharp pain that can last for months.  Canadian researchers have investigated the possible relationship between heart failure and vertebral fractures, and have found there’s an association.  They report their findings in the journal Circulation: Heart Failure.  

The study examined 623 patients attending a heart failure clinic in Edmonton, Alberta.  They all had complete sociodemographic, clinical, medication, and chest x-ray results.  About a third of the subjects were over 75, a third were women,  65% had ischemic cardiomyopathy, and 38% had atrial fibrillation (A-fib).  (Ischemic cardiomyopathy is a weakness of the heart muscle due to inadequate oxygen delivery, usually caused by coronary artery disease.)

Vertebral compression fractures were diagnosed from chest x-rays in 12% of the collective, with more than half of these having multiple fractures.  Only 15% of those with fractures were treated for osteoporosis. 

After adjusting for age, gender, weight, and medications, analysis showed that there  was a clear association between A-fib and vertebral fractures; 55% of the patients with vertebral fractures had A-fib, compared with 36% of those without fractures.  On the other hand, use of lipid-lowering drugs (e.g. statins) had an apparent protective effect; 47% of the patients with vertebral fractures had a history of lipid-lowering therapy versus 63% of those without fractures.

It’s possible that hyperaldosteronism (too much aldosterone, a male steroid hormone) may be responsible for the association between heart failure, osteoporosis, and atrial fibrillation.  Whatever the mechanism, doctors should be alert to the likely increased risk for such fractures in patients with heart failure, especially if they have A-fib too, so that precautionary measures can be taken.