Radiological vertebral fractures in hospitalized elderly patients with heart failure
G. Mazziotti1,2, M. Baracca2, M. Doga1, T. Porcelli1, P. Vescovi2 & A. Giustina1
Heart failure (HF) has been associated with bone loss and an increased risk of fragility fractures. Indeed, most of literature data on fractures were based on an historical and clinical approach focused on the identification of peripheral fractures, whereas the risk of vertebral fractures in this clinical setting is still unclear. In this study, we aimed at evaluating the prevalence of radiological vertebral fractures in 791 consecutive elderly and hospitalized patients (372 females and 419 males; median age: 75 years.; 190 patients with HF). The research focused on fractures of the thoracic spine, which were identified using chest X-ray routinely performed in the diagnostic work-up of HF. Exclusion criteria were: i) neoplastic diseases in progression; ii) systemic autoimmune diseases; iii) chronic therapy (>3 months) with oral and parenteral glucocorticoids; iv) chronic immobilization; v) trauma; vi) previous clinical history of HF without specific symptoms at the time of enrollment. Vertebral fractures were found in 170 patients (21.5%), the prevalence being significantly higher in patients with HF as compared to those without HF (38.9 vs 16.0%; P<0.001). The association between HF and vertebral fractures remained statistically significant (odds ratio 2.20, 95% C.I. 1.343.83) even after adjustment for age, sex, loop diuretic therapy, anticoagulant therapy, proton pump therapy, coexistent chronic obstructive pulmonary disease, diabetes mellitus and chronic liver diseases. In patients with HF, vertebral fractures were significantly correlated with duration of HF (odds ratio 1.09, 95% C.I. 1.061.10; P<0.001), female sex (odds ratio 5.85, 95% C.I. 1.9017.4; P=0.01), ischemic heart disease (odds ratio 2.55, 95% C.I. 1.036.29; P=0.04) and treatment with anti-osteoporotic drugs (odds ratio 2.87, 95% C.I. 1.097.55; P=0.03).
Our study shows for the first time that patients suffering from HF are at higher risk of developing vertebral fractures as compared to age/sex matched subjects selected in the same clinical environment.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.