Endocrine Abstracts

JOINT262

Background: Heart failure (HF), particularly dilated cardiomyopathy (DCM), is frequently associated with comorbidities, including osteoporosis and increased fracture risk. This heightened risk is potentially linked to shared pathophysiological mechanisms, such as chronic inflammation and neurohormonal activation. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has demonstrated significant benefits in HF management. However, its impact on bone metabolism remains unclear. This study investigated the effect of sacubitril/valsartan on bone turnover markers in patients with DCM.

Methods: This prospective, observational study enrolled 60 patients diagnosed with DCM (left ventricular ejection fraction ≤40%) and New York Heart Association (NYHA) functional class II-III. Patients were divided into two groups: the sacubitril/valsartan group (n =30) received standard HF therapy plus sacubitril/valsartan, while the control group (n =30) received standard HF therapy alone. Serum levels of bone turnover markers, including bone-specific alkaline phosphatase (BSAP, a marker of bone formation), C-terminal telopeptide of type I collagen (CTX, a marker of bone resorption), and osteocalcin (OC, another marker of bone formation), were measured at baseline and after 6 months of treatment.

Results: At baseline, no significant differences were observed in bone turnover markers between the two groups. After 6 months, the sacubitril/valsartan group demonstrated a significant decrease in CTX levels (mean change -12.5 pg/mL, P<0.05) compared to the control group (mean change +2.1 pg/mL, P = 0.32). BSAP and OC levels did not show statistically significant changes in either group. The change in CTX correlated positively with the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of cardiac stress, in the sacubitril/valsartan group (r=0.45, P<0.05). This suggests that the reduction in bone resorption may be related to improved cardiac function.

Conclusion: This study suggests that sacubitril/valsartan may have a beneficial effect on bone metabolism in patients with DCM by reducing bone resorption, as evidenced by a decrease in CTX levels. The correlation between changes in CTX and NT-proBNP suggests a potential link between improved cardiac function and reduced bone resorption. Further large-scale, randomized controlled trials are needed to confirm these findings and explore the underlying mechanisms. These findings highlight the potential pleiotropic effects of sacubitril/valsartan beyond its established cardiovascular benefits.

References: 1. Ellulu MS, et al. Osteoporosis and heart failure: a two-way street. Heart Fail Rev. 2013;18(5):597-606.2. Body JJ, et al. International Osteoporosis Foundation (IOF) and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines for the diagnosis and management of osteoporosis. Osteoporos Int. 2018;29(10):2143-2165.