Heart Failure Boosts Bone Fracture Risk

Patients Less Likely to Exercise, Raising Their Risk of Fractures

From the WebMD Archives

Oct. 20, 2008 -- People with heart failure are much more likely to suffer bone fractures than other cardiac patients, in part because they're less likely to exercise, a new study says.

However, "these patients can go through cardiac rehabilitation and increase their exercise capacity, reducing risk of weak bones and fracture," Justin Ezekowitz, MD, lead author of the study, tells WebMD.

Ezekowitz, director of the Heart Function Clinic at the University of Alberta in Canada, also says people with heart failure should eat bone-strengthening diets and be screened for osteoporosis.

The study, published in Circulation: Journal of the American Heart Association, shows that people with heart failure are at higher risk for hospitalization and debilitating hip fractures than healthier heart patients of similar ages. Heart failure, also called congestive heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. Fractures, especially those affecting the hip bones, can be fatal by increasing the risk of serious lung infections and major blood clots. Thirty percent of patients who suffer a hip fracture die within one year.

The study included 16,294 patients with heart disease who'd visited emergency rooms in Alberta between 1998 and 2001. The patients' ages ranged from 68 to 84.

One year after visiting an ER, 4.6% of people with heart failure had experienced a fracture, compared with 1% of comparably aged heart patients. The one-year rate for hip fracture of those with heart failure was 1.3%, vs. only 0.1% for other heart patients.

Even after accounting for other health issues, age, gender, and various medications, "we found heart failure patients had a fourfold risk of fracture" and a sixfold increase in hip fractures. "Maybe they aren't getting enough calcium or vitamin D, or exposure to sunlight," Ezekowitz tells WebMD

Commenting on the study, Andrew Smith, medical director of the heart failure and transplant program at Emory University in Atlanta, says he found the link between heart failure and fractures important and interesting.

He says the study should result in "increased awareness among physicians that these patients may be more likely to have fractures" and that more heart patients should be screened for bone density.


Heart failure is a leading cause of hospitalizations and death, occurring in 2.2% of the general population and 8.4% in those older than 75. Osteoporosis affects 10 million Americans. About 25% of women and 12% of men over 50 have osteoporosis.

To reduce the risk of developing osteoporosis, Ezekowitz tells WebMD that:

  • Everyone should exercise their entire lives.
  • Vitamin D should be a major ingredient in all diets, from childhood on up.
  • Everyone should try to get plenty of sunlight, a major source of vitamin D.
  • Smokers should quit.

"The take-home message is twofold," he says. "People who treat patients with heart failure need to screen them for osteoporosis. No. 2, it's best to exercise outside in the sun. For people in a nursing home, they need to get outside."

Smith points out that not everyone with heart problems ends up with heart failure, which "doesn't mean your heart is going to suddenly stop." Instead, he says, "people can live with heart failure for years."

WebMD Health News Reviewed by Elizabeth Klodas, MD, FACC on October 20, 2008



Circulation: Journal of the American Heart Association, Nov. 4, 2008.

Justin Ezekowitz, MD, director of Heart Function Clinic, University of Alberta, Canada.

Andrew Smith, MD, medical director, heart failure and transplant program, Emory University School of Medicine, Atlanta.

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