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(Circulation. 2008;118:1946-1952.)
© 2008 American Heart Association, Inc.

Heart Failure

Heart Failure Is a Risk Factor for Orthopedic Fracture

A Population-Based Analysis of 16 294 Patients

Sean van Diepen, MD; Sumit R. Majumdar, MD, MPH; Jeffrey A. Bakal, PhD; Finlay A. McAlister, MD, MSc; Justin A. Ezekowitz, MBBCh, MSc

From the Division of Cardiology (S.v.D., J.A.E.) and Division of General Medicine (S.R.M., F.A.M.), Department of Medicine, and Canadian VIGOUR Center (J.A.B., J.A.E.), University of Alberta, Alberta, Edmonton, Canada.

Correspondence to Justin A. Ezekowitz, MBBCh, MSc, FRCPC, 2C2 Cardiology, University of Alberta, 8440 112 St, Edmonton, Alberta, Canada. E-mail justin.ezekowitz{at}ualberta.ca

Received April 7, 2008; accepted September 9, 2008.

Background— Heart failure (HF) is associated with factors that may contribute to accelerated bone loss and subsequent fractures. Whether it leads to an increased fracture risk is unknown.

Methods and Results— A population-based cohort of consecutive patients 65 years of age with cardiovascular disease presenting to all emergency rooms between 1998 and 2001 in Alberta, Canada (n=16294 patients), was used. The 2041 patients with a new diagnosis of HF were compared with a control group of 14 253 patients with non-HF cardiovascular diagnoses. The primary outcome was any orthopedic fracture requiring hospital admission in the year after the emergency room visit. Patients with HF had a median age of 78 years (interquartile range, 72 to 84 years), and 51.9% were female; control subjects had a median age of 73 years (interquartile range, 68 to 79 years), and 53.2% were female. In the first year after the emergency room visit, 4.6% of the HF cohort (n=93) and 1.0% of patients without HF (n=147) sustained an orthopedic fracture (P<0.001). Hip fractures occurred in 26 HF patients (1.3%) and 18 patients (0.1%) without HF (P<0.001). After multivariable adjustment, HF was independently associated with a greater risk of any orthopedic fracture (adjusted odds ratio, 4.0; 95% CI, 2.9 to 5.3) or hip fracture (adjusted odds ratio, 6.3; 95% CI, 3.4 to 11.8).

Conclusions— HF is associated with an increased risk of subsequent orthopedic fracture, particularly hip fracture. This suggests that screening for and treatment of osteoporosis to reduce fracture risk need to be considered in those with HF.

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