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Condurache DG, D’Angelo S, Salih AM, Szabo L, McCracken C, Mahmood A, Curtis EM, Altmann A, Petersen SE, Harvey NC, Raisi-Estabragh Z. Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis. JBMR Plus 2024; 8:ziae058. [PMID: 38784722 PMCID: PMC11114472 DOI: 10.1093/jbmrpl/ziae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
This study examined the association of estimated heel bone mineral density (eBMD, derived from quantitative ultrasound) with: (1) prevalent and incident cardiovascular diseases (CVDs: ischemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), non-ischemic cardiomyopathy (NICM), arrhythmia), (2) mortality (all-cause, CVD, IHD), and (3) cardiovascular magnetic resonance (CMR) measures of left ventricular and atrial structure and function and aortic distensibility, in the UK Biobank. Clinical outcomes were ascertained using health record linkage over 12.3 yr of prospective follow-up. Two-sample Mendelian randomization (MR) was conducted to assess causal associations between BMD and CMR metrics using genetic instrumental variables identified from published genome-wide association studies. The analysis included 485 257 participants (55% women, mean age 56.5 ± 8.1 yr). Higher heel eBMD was associated with lower odds of all prevalent CVDs considered. The greatest magnitude of effect was seen in association with HF and NICM, where 1-SD increase in eBMD was associated with 15% lower odds of HF and 16% lower odds of NICM. Association between eBMD and incident IHD and MI was non-significant; the strongest relationship was with incident HF (SHR: 0.90 [95% CI, 0.89-0.92]). Higher eBMD was associated with a decreased risk in all-cause, CVD, and IHD mortality, in the fully adjusted model. Higher eBMD was associated with greater aortic distensibility; associations with other CMR metrics were null. Higher heel eBMD is linked to reduced risk of a range of prevalent and incident CVD and mortality outcomes. Although observational analyses suggest associations between higher eBMD and greater aortic compliance, MR analysis did not support a causal relationship between genetically predicted BMD and CMR phenotypes. These findings support the notion that bone-cardiovascular associations reflect shared risk factors/mechanisms rather than direct causal pathways.
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Affiliation(s)
- Dorina-Gabriela Condurache
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
| | - Stefania D’Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton SO16 6YD, England,United Kingdom
| | - Ahmed M Salih
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, England, United Kingdom
- Department of Computer Science, Faculty of Science, University of Zakho, Zakho 42002, Kurdistan Region, Iraq
| | - Liliana Szabo
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, England, United Kingdom
| | - Adil Mahmood
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton SO16 6YD, England,United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, England, United Kingdom
| | - Andre Altmann
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London, London WC1E 6BT, England, United Kingdom
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
- Health Data Research UK, British Heart Foundation Data Science Centre, London NW1 2BE, England, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton SO16 6YD, England,United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, England, United Kingdom
| | - Zahra Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
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Haruyama N, Nakayama M, Yamada S, Tanaka S, Hiyamuta H, Taniguchi M, Tokumoto M, Tsuruya K, Kitazono T, Nakano T. History of fragility fracture is associated with cardiovascular mortality in hemodialysis patients: the Q-Cohort study. J Bone Miner Metab 2024; 42:253-263. [PMID: 38509305 DOI: 10.1007/s00774-024-01501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION In patients undergoing dialysis, major bone fracture is associated with a high risk of mortality, including death of cardiovascular (CV) origin. In the present study, we aimed to determine whether a history of fragility fracture is a predictor of CV death in patients undergoing hemodialysis with long-term follow-up. MATERIALS AND METHODS In total, 3499 patients undergoing hemodialysis were analyzed for 10 years. We evaluated the history of fragility fracture in each patient at enrollment. The primary outcome was CV death. A Cox proportional hazard model and a competing risk approach were applied to determine the association between a history of fragility fracture and CV death. RESULTS A total of 346 patients had a history of fragility fracture at enrollment. During a median follow-up of 8.8 years, 1730 (49.4%) patients died. Among them, 621 patients experienced CV death. Multivariable Cox analyses after adjustment for confounding variables showed that a history of fragility fracture was associated with CV death (hazard ratio, 1.47; 95% confidence interval, 1.16-1.85). In the Fine-Gray regression model, a history of fragility fracture was an independent risk factor for CV death (subdistribution hazard ratio, 1.36; 95% confidence interval, 1.07-1.72). CONCLUSION In a large cohort of patients undergoing hemodialysis, a history of fragility fracture was an independent predictor of CV death.
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Affiliation(s)
- Naoki Haruyama
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, Fukuoka, Japan
| | - Masaru Nakayama
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Masanori Tokumoto
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Yang Y, Huang Y. Association between bone mineral density and cardiovascular disease in older adults. Front Public Health 2023; 11:1103403. [PMID: 37427263 PMCID: PMC10328748 DOI: 10.3389/fpubh.2023.1103403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aims Cardiovascular disease and osteoporosis are common diseases in older adults with high morbidity. The study on the interaction between the two in pathogenic mechanisms has been paid much attention by the majority of researchers. This study aimed to explore the relationship between bone mineral density and cardiovascular disease in older adults. Methods The primary data was downloaded from the National Health and Nutrition Examination Survey database of the United States. Multivariate logistic regression model, generalized additive model, and smooth curve fitting were used to explore the relationship between bone mineral density and cardiovascular events risk. When a curve relationship was found, a two-piecewise linear model was used to calculate the inflection point. In addition, subgroup analysis was also performed. Results A total of 2097 subjects were included in this study. After adjusting for potential confounders, no significant association was found between lumbar bone mineral density and cardiovascular disease, while femur bone mineral density had a non-linear relationship with cardiovascular disease, with an inflection point of 0.741 gm/cm2. When bone mineral density was <0.741 gm/cm2, the risk of cardiovascular disease decreased speedily. Once bone mineral density exceeded this value, the risk of cardiovascular disease continued to decrease, but the trend became significantly slower. Compared with patients with normal bone mass, osteoporosis was associated with a 2.05-fold increased risk of cardiovascular disease (95% CI 1.68-5.52). There were no significant differences in interaction tests of all subgroups (p for interaction >0.05) except race. Conclusion Our results indicated that bone mineral density was closely associated with the prevalence of cardiovascular disease in older adults over 60 years old, especially the femur bone mineral density was negatively non-linear associated with cardiovascular disease risk, with an inflection point of 0.741 gm/cm2.
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Gao H, Patel S, Fohtung RB, Cawthon PM, Newman AB, Cauley JA, Carbone L, Chaves PHM, Stein PK, Civitelli R, Kizer JR. Sex- and race-specific associations of bone mineral density with incident heart failure and its subtypes in older adults. J Am Geriatr Soc 2023; 71:742-755. [PMID: 36334030 PMCID: PMC10023291 DOI: 10.1111/jgs.18121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have suggested an association between bone mineral density (BMD) and heart failure (HF) risk that may be race-dependent. METHODS We evaluated the relationship between BMD and incident HF in a cohort of older adults, the Health, Aging, and Body Composition (Health ABC) study (n = 2835), and next performed a pooled analysis involving a second older cohort, the Cardiovascular Health Study (n = 1268). Hip BMD was measured by dual-energy X-ray absorptiometry in both cohorts and spine BMD by computed tomography in a subset from Health ABC. RESULTS In Health ABC, lower BMD at the total hip was associated with higher incident HF in Black women after multivariable adjustment. Similar associations were found for BMD at the femoral neck and spine. In both cohorts, pooled analysis again revealed an association between lower total hip BMD and increased risk of HF in Black women (HR = 1.41 per 0.1-g/cm2 decrement [95% CI = 1.23-1.62]), and showed the same to be true for White men (HR = 1.12 [1.03-1.21]). There was a decreased risk of HF in Black men (HR 0.80 [0.70-0.91]), but no relationship in White women. The associations were numerically stronger with HFpEF for Black women and White men, and with HFrEF for Black men. Findings were similar for femoral neck BMD. Sensitivity analyses delaying HF follow-up by 2 years eliminated the association in Black men. CONCLUSIONS Lower BMD was associated with higher risk of HF and especially HFpEF in older Black women and White men, highlighting the need for additional investigation into underlying mechanisms.
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Affiliation(s)
- Hans Gao
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center; Los Angeles, CA
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Raymond B. Fohtung
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Peggy M. Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Laura Carbone
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta GA
| | - Paulo H. M. Chaves
- Division of Internal Medicine and Benjamin Leon Jr Family Center for Geriatric Research and Education, Department of Medicine, Herbert Wertheim College of Medicine of Florida International University, Miami, FL
| | - Phyllis K. Stein
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO
| | - Roberto Civitelli
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jorge R. Kizer
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center; Los Angeles, CA
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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Guan Z, Yuan W, Jia J, Zhang C, Zhu J, Huang J, Zhang W, Fan D, Leng H, Li Z, Xu Y, Song C. Bone mass loss in chronic heart failure is associated with sympathetic nerve activation. Bone 2023; 166:116596. [PMID: 36307018 DOI: 10.1016/j.bone.2022.116596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/02/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Chronic heart failure causes osteoporosis, but the mechanism remains unclear. The sympathetic nerve plays an important role in both bone metabolism and cardiovascular function. METHODS Thirty-six adult male SD rats were randomly divided into the following four groups: sham surgery (Sham) group, guanethidine (GD) group, abdominal transverse aorta coarctation-induced heart failure + normal saline (TAC) group, and TAC + guanethidine (TAC + GD) group. Normal saline (0.9 % NaCl) or guanethidine (40 mg/kg/ml) was intraperitoneally injected daily for 5 weeks. Then, DXA, micro-CT, ELISA and RT-PCR analyses were performed 12 weeks after treatment. RESULTS The bone loss in rats subjected to TAC-induced chronic heart failure and chemical sympathectomy with guanethidine was increased. Serum norepinephrine levels were increased in rats with TAC-induced heart failure but were decreased in TAC-induced heart failure rats treated with guanethidine. The expression of α2A adrenergic receptor, α2C adrenergic receptor, osteoprotegerin (OPG), and osteocalcin in the tibia decreased in the TAC-induced heart failure group, and the expression of β1 adrenergic receptor, β2 adrenergic receptor, receptor activator of nuclear factor-κ B ligand (RANKL), and RANKL/OPG in the tibia increased in the heart failure group. In addition, these changes in gene expression levels were rescued by chemical sympathectomy with guanethidine. CONCLUSIONS TAC-induced chronic heart failure is associated with bone mass loss, and the sympathetic nerve plays a significant role in heart failure-related bone mass loss. MINI ABSTRACT The present study supports the hypothesis that heart failure is related to bone loss, and the excessive activation of sympathetic nerves participates in this pathophysiological process. The present study suggests a potential pathological mechanism of osteoporosis associated with heart failure and new perspectives for developing strategies for heart failure-related bone loss.
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Affiliation(s)
- Zhiyuan Guan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Wanqiong Yuan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jialin Jia
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Chenggui Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Junxiong Zhu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jie Huang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Wang Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Dongwei Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Huijie Leng
- Department of Orthopedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Zijian Li
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Diseases, Beijing, China.
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Skripnikova IA, Yaralieva EK, Drapkina OM. Heart failure and osteoporosis: common pathogenetic components. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This literature review reflects modern ideas about the combination of heart failure (HF) and osteoporosis, common risk factors for these diseases, and pathophysiological mechanisms of metabolic bone diseases in HF. Despite a growing number of studies on the combined cardiovascular and skeletal system pathology, the relationship between a decrease in bone mineral density and HF risk remains poorly understood. Both conditions are common causes of disability, death, prolonged hospitalizations and a significant reduction in quality of life, while its combination exacerbates their course and increases the incidence of adverse outcomes, which is a heavy burden for a patient and health care in general. Keywords: heart failure, osteoporosis, bone mineral density, bone metabolism.
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Affiliation(s)
- I. A. Skripnikova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. K. Yaralieva
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Bandeira F, de Oliveira LB, Caldeira RB, Toscano LS. Skeletal consequences of heart failure. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221135501. [PMID: 36321835 PMCID: PMC9634191 DOI: 10.1177/17455057221135501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023]
Abstract
Heart failure (HF) is a prevalent clinical syndrome that causes significant physical limitations. Osteoporosis is also an important cause of loss of functionality, and it mainly affects women. There are several reports linking HF and osteoporosis, and both share risk factors. Most of the data available so far point to bone fragility as a consequence of HF, and several mechanisms have been identified to explain this relationship. Among the proposed pathophysiological mechanisms are the hyperactivation of the renin-angiotensin-aldosterone system and the increase in parathyroid hormone, functional limitation, production of inflammatory mediators and the use of drugs for HF. The role of osteoprotegerin has gained attention owing to its cardiovascular and skeletal effects, its observed deficiency during the postmenopausal period along with its compensatory increases in HF and severe osteoporosis. The objective of this review was to perform a literature search for the main evidence on skeletal impairment in HF, with emphasis on women. As for epidemiological studies, we selected data from 3 meta-analyses and 20 individual observational studies, which together showed the interrelationship between the two clinical conditions in terms of both decreased bone density and increased fracture risk. In conclusion, HF and osteoporosis are interrelated conditions mediated by complex pathophysiological mechanisms which may be more relevant for postmenopausal women, considered to be a vulnerable population for both cardiovascular diseases and bone fragility.
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Affiliation(s)
- Francisco Bandeira
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
| | - Lucian Batista de Oliveira
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
| | - Rodrigo Botelho Caldeira
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
| | - Leticia Saldanha Toscano
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
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Prevost S. Beware! Some crucial information is left unattended on our myocardial perfusion scans! J Nucl Cardiol 2021; 28:2642-2643. [PMID: 31286421 DOI: 10.1007/s12350-019-01803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Sylvain Prevost
- Nuclear Medicine and Radiobiology, CHUS, Université de Sherbrooke, 3001, 12e Ave Nord, Sherbrooke, J1H 5H3, Canada.
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Vaikunth SS, Leonard MB, Whitehead KK, Goldberg DJ, Rychik J, Zemel BS, Avitabile CM. Deficits in the Functional Muscle-Bone Unit in Youths with Fontan Physiology. J Pediatr 2021; 238:202-207. [PMID: 34214589 PMCID: PMC8634795 DOI: 10.1016/j.jpeds.2021.06.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether dual energy X-ray absorptiometry (DXA), a clinically available tool, mirrors the magnitude of deficits in trabecular and cortical bone mineral density (BMD) demonstrated on peripheral quantitative computed tomography in youth with Fontan physiology. STUDY DESIGN We aimed to describe DXA-derived BMD at multiple sites and to investigate the relationship between BMD and leg lean mass, a surrogate for skeletal muscle loading. Subjects with Fontan (n = 46; aged 5-20 years) underwent DXA in a cross-sectional study of growth and bone and muscle health as described previously. Data from the Bone Mineral Density in Childhood Study were used to calculate age-, sex-, and race-specific BMD z-scores of the whole body, lumbar spine, hip, femoral neck, distal one-third radius, ultradistal radius, and leg lean mass z-score (LLMZ). RESULTS Fontan BMD z-scores were significantly lower than reference at all sites-whole body, -0.34 ± 0.85 (P = .01); spine, -0.41 ± 0.96 (P = .008); hip, -0.75 ± 1.1 (P < .001); femoral neck, -0.73 ± 1.0 (P < .001); distal one-third radius, -0.87 ± 1.1 (P < .001); and ultradistal radius. -0.92 ± 1.03 (P < .001)-as was LLMZ (-0.93 ± 1.1; P < .001). Lower LLMZ was associated with lower BMD of the whole body (R2 = 0.40; P < .001), lumbar spine (R2 = 0.16; P = .005), total hip (R2 = 0.32; P < .001), femoral neck (R2 = 0.47; P < .001), and ultradistal radius (R2 = 0.35; P < .001). CONCLUSIONS Patients with Fontan have marked deficits in both cortical (hip, distal one-third radius) and trabecular (lumbar spine, femoral neck, ultradistal radius) BMD. Lower LLMZ is associated with lower BMD and may reflect inadequate skeletal muscle loading. Interventions to increase muscle mass may improve bone accrual.
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Affiliation(s)
- Sumeet S. Vaikunth
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mary B. Leonard
- Departments of Medicine and Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kevin K. Whitehead
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Goldberg
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Babette S. Zemel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine M. Avitabile
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study. Eur J Epidemiol 2021; 36:1169-1177. [PMID: 34515906 PMCID: PMC8629874 DOI: 10.1007/s10654-021-00803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
The association between bone mineral density (BMD) and cardiovascular disease (CVD) is not fully understood. We evaluated BMD as a risk factor for cardiovascular disease and specifically atrial fibrillation (AF), acute myocardial infarction (AMI), ischemic (IS) and hemorrhagic stroke (HS) and heart failure (HF) in men and women. This prospective population cohort utilized data on 22 857 adults from the second and third surveys of the HUNT Study in Norway free from CVD at baseline. BMD was measured using single and dual-energy X-ray absorptiometry in the non-dominant distal forearm and T-score was calculated. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from adjusted cox proportional hazards models. The analyses were sex-stratified, and models were adjusted for age, age-squared, BMI, physical activity, smoking status, alcohol use, and education level. Additionally, in women, we adjusted for estrogen use and postmenopause. During a mean follow-up of 13.6 ± 5.7 years, 2 928 individuals (12.8%) developed fatal or non-fatal CVD, 1 020 AF (4.5%), 1 172 AMI (5.1%), 1 389 IS (6.1%), 264 HS (1.1%), and 464 HF (2.0%). For every 1 unit decrease in BMD T-score the HR for any CVD was 1.01 (95% CI 0.98 to 1.04) in women and 0.99 (95% CI 0.94 to 1.03) in men. Point estimates for the four cardiovascular outcomes ranged from slightly protective (HR 0.95 for AF in men) to slightly deleterious (HR 1.12 for HS in men). We found no evidence of association of lower distal forearm BMD with CVD, AF, AMI, IS, HS, and HF.
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Abe S, Yoshihisa A, Ichijo Y, Kimishima Y, Yokokawa T, Misaka T, Sato T, Oikawa M, Kobayashi A, Kaneshiro T, Nakazato K, Takeishi Y. Serum TRACP5b, a Marker of Bone Resorption, Is Associated With Adverse Cardiac Prognosis in Hospitalized Patients With Heart Failure. CJC Open 2021; 3:470-478. [PMID: 34027350 PMCID: PMC8129440 DOI: 10.1016/j.cjco.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Tartrate-resistant acid phosphatase type 5b (TRACP5b) is derived from osteoclasts, and has been used as a marker of osteoporosis (bone resorption). Although heart failure (HF) is associated with catabolic bone remodelling, serum TRACP5b levels have not been rigourously examined in patients with HF. Methods We conducted a prospective observational study of 688 decompensated HF patients who had been discharged and whose TRACP5b had been measured. These patients were divided into tertiles on the basis of serum TRACP5b levels: first (TRACP5b < 316 mU/dL, n = 229), second (TRACP5b 316-489 mU/dL, n = 229), and third (TRACP5b ≥ 490 mU/dL, n = 230). We compared the patient baseline characteristics, exercise capacity, and their postdischarge prognosis, including cardiac mortality and cardiac events such as cardiac death and worsening HF. Results Age was significantly higher, and prevalence of female sex and anemia was significantly higher in the third tertile than in the first and second tertiles (P < 0.05, respectively). Circulating TRACP5b levels were correlated with peak breath-by-breath oxygen consumption, but not with left ventricular ejection fraction. In the Kaplan-Meier analysis (mean follow-up, 426 days), cardiac mortality and cardiac event rates progressively increased from the first to the third tertiles (P < 0.05, respectively). In the multivariable Cox proportional hazard analysis, the third tertile was an independent predictor of cardiac mortality and cardiac events (cardiac mortality hazard ratio, 2.493; P = 0.040; cardiac events hazard ratio, 1.687; P = 0.030). Conclusions High serum levels of TRACP5b, a marker of bone resorption, are associated with high cardiac mortality and cardiac events, accompanied by impaired exercise capacity.
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Affiliation(s)
- Satoshi Abe
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Kimishima
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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12
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Cellini M, Piccini S, Ferrante G, Carrone F, Olivetti R, Cicorella N, Aroldi M, Pini D, Centanni M, Lania AG, Mazziotti G. Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study. J Endocrinol Invest 2020; 43:1561-1569. [PMID: 32240522 DOI: 10.1007/s40618-020-01237-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/23/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF. METHODS 84 patients (44 males, median age 48.5 years, range 43-65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6-12 months during the study period. RESULTS At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001). CONCLUSIONS This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.
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Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - S Piccini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - R Olivetti
- Endocrinology Unit, ASST Carlo Poma, Mantova, Italy
| | - N Cicorella
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - M Aroldi
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - D Pini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - M Centanni
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - A G Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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13
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Katano S, Yano T, Tsukada T, Kouzu H, Honma S, Inoue T, Takamura Y, Nagaoka R, Ishigo T, Watanabe A, Ohori K, Koyama M, Nagano N, Fujito T, Nishikawa R, Takashima H, Hashimoto A, Katayose M, Miura T. Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure. Circ J 2020; 84:2224-2234. [PMID: 33116003 DOI: 10.1253/circj.cj-20-0593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66-82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74-86] vs. 72 [IQR, 62-80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers. CONCLUSIONS Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.
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Affiliation(s)
- Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takanori Tsukada
- Cardiac Rehabilitation Center, Social Welfare Corporation, Hokkaido Social Work Association Obihiro Hospital
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Suguru Honma
- Department of Rehabilitation, Sapporo Cardiovascular Hospital
| | - Takuya Inoue
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Yuhei Takamura
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Ayako Watanabe
- Division of Nursing, Sapporo Medical University Hospital
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Department of Cardiology, Hokkaido Cardiovascular Hospital
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine
| | - Masaki Katayose
- Department of Public Health, Sapporo Medical University School of Medicine.,Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
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14
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Rubin KH, Möller S, Choudhury A, Zorina O, Kalsekar S, Eriksen EF, Andersen M, Abrahamsen B. Cardiovascular and skeletal safety of zoledronic acid in osteoporosis observational, matched cohort study using Danish and Swedish health registries. Bone 2020; 134:115296. [PMID: 32097760 DOI: 10.1016/j.bone.2020.115296] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/17/2020] [Accepted: 02/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This observational safety study used national registers to compare the real world cardiovascular and skeletal safety of zoledronic acid (ZA) against oral bisphosphonates (oBP) and untreated population controls. METHODS Propensity score matched cohort study in Sweden and Denmark. RESULTS Matched cohort 1 included 8739 ZA users and 25,577 oBP users while matched cohort 2 included 8731 ZA users and 25,924 untreated subjects. In comparison to oBP users, heart failure risk was higher in ZA users, with an adjusted HR (adj) (95%CI) of 1.17 (1.04;1.32) and a higher all-cause mortality (adj HR 1.24 (1.15; 1.34)), however, there was no increased risk of cardiovascular mortality. In the comparison to untreated subjects, ZA users showed a higher risk of atrial fibrillation, adj HR 1.18 (1.05;1.32), arrhythmias adj HR 1.18 (1.06;1.31), and heart failure, adj HR 1.38 (1.24;1.54). Cardiovascular mortality was lower in ZA users (adj HR 0.87 (0.77; 0.98)) and risk of adverse skeletal outcomes was significantly higher, reflecting more severe osteoporosis in these patients. There was no association of cardiovascular risk with increasing exposure time. Sensitivity analyses produced similar findings with no substantial changes in event rates. CONCLUSIONS We noted an increased risk of heart failure, fractures and death among ZA users compared with oral BP. The risk of cardiovascular and skeletal outcomes was higher in ZA users than in matched population controls, but there was no increase in cardiovascular mortality in ZA users compared to oral BP or untreated controls. Despite propensity score matching, it is not possible to determine with certainty whether the increased risk of cardiovascular outcomes is consistent with a true drug effect or higher baseline risk in patients who begin ZA treatment.
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Affiliation(s)
- Katrine Hass Rubin
- OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Sören Möller
- OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | | | | | | | - Erik F Eriksen
- Department of Endocrinology, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Clinical Epidemiology Unit, Karolinska Institutet Stockholm, Sweden; Department of Drug Design and Pharmacology, University of Copenhagen, Denmark
| | - Bo Abrahamsen
- OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Medicine, Holbæk, Hospital, Denmark.
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15
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Loncar G, Cvetinovic N, Lainscak M, Isaković A, von Haehling S. Bone in heart failure. J Cachexia Sarcopenia Muscle 2020; 11:381-393. [PMID: 32087616 PMCID: PMC7113538 DOI: 10.1002/jcsm.12516] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in osteoporosis and reduced bone mineral density affecting not only post-menopausal women but also men, particularly with coexisting chronic diseases. Bone status in patients with stable chronic heart failure (HF) has been rarely studied so far. HF and osteoporosis are highly prevalent aging-related syndromes that exact a huge impact on society. Both disorders are common causes of loss of function and independence, and of prolonged hospitalizations, presenting a heavy burden on the health care system. The most devastating complication of osteoporosis is hip fracture, which is associated with high mortality risk and among those who survive, leads to a loss of function and independence often necessitating admission to long-term care. Current HF guidelines do not suggest screening methods or patient education in terms of osteoporosis or osteoporotic fracture. This review may serve as a solid base to discuss the need for bone health evaluation in HF patients.
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Affiliation(s)
- Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center 'Dr. Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
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16
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Skripnikova IA, Alikhanova NA, Kolchinа MA, Myagkova MA, Kosmatova OV. Atherosclerosis and Osteoporosis. Common Targets for the Effects of Cardiovascular and Anti-osteoporotic Drugs (Part I). The Effect of Cardiovascular Drugs on Bone Strength. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-1-69-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Daily use of antihypertensive and lipid-lowering drugs in clinical practice dictates the need for knowledge of their pleiotropic effects. The article presents the results of studies of the effect of cardiovascular drugs, such as statins, beta-blockers, ACE inhibitors, diuretics, calcium antagonists and nitrates on bone mineral density and fractures associated with osteoporosis. The mechanisms of action of drugs on bone mass, markers of bone metabolism, the frequency of fractures in osteoporosis are discussed. Most studies show that the use of cardiac drugs along with a positive effect on the vascular wall, slow bone resorption and increase bone mass. Knowledge of the additional effect on bone metabolism of drugs used in cardiovascular diseases allows to choose an adequate therapy and improve the prognosis of both diseases.
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Affiliation(s)
| | | | - M. A. Kolchinа
- National Medical Research Center for Preventive Medicine
| | - M. A. Myagkova
- National Medical Research Center for Preventive Medicine
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17
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Smirnova MD, Barinova IV, Fofanova TV, Blankova ZN, Svirida ON, Ageev FT, Boytsov SA. What “new” factors should be considered when assessing cardiovascular risk? КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-6-77-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
One of the causes of high mortality from cardiovascular diseases is the lack of effective measures for the primary and secondary prevention of cardiovascular complications (CCO), due to the difficulty of timely identification risk factors (RF) and individuals with a high individual risk of CCO. This is especially true for patients from low/mean risk. This group is heterogeneous. Often, clinical manifestations of atherosclerosis occur for the first time without “classical” RF. Possible factors that increase the risk of developing cardiovascular diseases and CCO, are: heart rate, increased formation of advanced glycation endproducts, disorders of bone mineral metabolism, thyroid function, low adherence to therapy, psychosocial factors and climatic features. This review is devoted to the analysis of the evidence base of the influence of these “new” CCO RF and the individual patient prognosis.
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Affiliation(s)
- M. D. Smirnova
- Scientific Medical Research Center of Cardiology of the Ministry of Health
| | - I. V. Barinova
- Scientific Medical Research Center of Cardiology of the Ministry of Health
| | - T. V. Fofanova
- Scientific Medical Research Center of Cardiology of the Ministry of Health
| | - Z. N. Blankova
- Scientific Medical Research Center of Cardiology of the Ministry of Health
| | - O. N. Svirida
- Scientific Medical Research Center of Cardiology of the Ministry of Health
| | - F. T. Ageev
- Scientific Medical Research Center of Cardiology of the Ministry of Health
| | - S. A. Boytsov
- Scientific Medical Research Center of Cardiology of the Ministry of Health
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18
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Kervin T, Thangarajh M. The Relationship Between Bone Mineral Density and Cardiovascular Function in Duchenne Muscular Dystrophy: A Retrospective Cohort Study. PLOS CURRENTS 2018; 10. [PMID: 29623244 PMCID: PMC5878101 DOI: 10.1371/currents.md.ee7ac0ec8c19a47b114737f9c2714779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION: Duchenne muscular dystrophy (DMD) is an X-linked genetic disorder that causes progressive skeletal and cardiac muscle weakness in boys. Cardiac dysfunction is a frequent cause of death in DMD. Glucocorticoids are the standard of care in DMD. The long-term use of oral glucocorticoids in DMD is complicated by poor bone health. Epidemiological studies suggest a biological link between the loss of bone mineral density (BMD) and cardiovascular disease, including coronary artery and cerebrovascular diseases. Whether an association between low BMD and cardiac dysfunction occurs in DMD boys has not yet been studied. The objective of this retrospective cohort study was to examine the relationship between BMD and cardiovascular health in DMD. METHODS: Retrospective data analyses was performed from de-identified medical records from a tertiary academic medical center. Whole body BMD was measured using dual-energy xray absorptiometry (DEXA) scan and left ventricular ejection fraction (LVEF) was measured using echocardiogram. Linear regression was used to evaluate the relationship between BMD and LVEF. RESULTS: Data was analyzed from a total of 32 boys with DMD. The mean age at which baseline BMD measurements was obtained of 11±3 (SD) years. The worst LVEF was measured at a mean of 23.7±21.8 (SD) months after the baseline BMD measurement. The final adjusted linear regression of the relationship between baseline BMD z-score and worst LVEF was not statistically significant (ß=0.41, p‑value=0.6455). DISCUSSION: In this cohort of boys with DMD, BMD was not associated with LVEF dysfunction up to 79 months later. Future research with a longer longitudinal follow-up period is warranted to evaluate the relationship between BMD and cardiovascular disease in DMD.
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Affiliation(s)
- Tara Kervin
- Statistics Collaborative, Inc., Washington, D.C., USA
| | - Mathula Thangarajh
- Department of Neurology, Children's National Health System, George Washington School of Medicine, Washington, D.C., USA
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19
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Verheyen N, Grübler MR, Catena C, Fahrleitner-Pammer A, van Ballegooijen AJ. The Bone-Cardiovascular Axis: Mechanisms and Clinical Relevance. Int J Endocrinol 2018; 2018:9689106. [PMID: 29681938 PMCID: PMC5841107 DOI: 10.1155/2018/9689106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Martin R. Grübler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Adriana J. van Ballegooijen
- Department of Health Sciences, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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20
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Fisher A, Fisher L, Srikusalanukul W, Smith PN. Bone Turnover Status: Classification Model and Clinical Implications. Int J Med Sci 2018; 15:323-338. [PMID: 29511368 PMCID: PMC5835703 DOI: 10.7150/ijms.22747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness. Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures. Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days. Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.,Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.,Australian National University Medical School, Canberra, ACT, Australia
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia
| | - Paul N Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.,Australian National University Medical School, Canberra, ACT, Australia
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21
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Chiu CZ, Yeh JH, Shyu KG, Hou SM, Lin CL, Liang JA. Can osteoporosis increase the incidence of heart failure in adults? Curr Med Res Opin 2017; 33:1119-1125. [PMID: 28301957 DOI: 10.1080/03007995.2017.1308343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent studies have suggested shared comorbidities between heart failure and osteoporosis. In addition, patients with osteoporosis are associated with increased risks of developing cardiovascular disease. METHODS A retrospective cohort analysis was conducted to determine the association between osteoporosis and heart failure. Data was from the Longitudinal Health Insurance Database 2000 (LHID 2000), Taiwan. Patients with newly diagnosed osteoporosis were identified, and osteoporosis-free controls were randomly selected from the general population and frequency matched according to age, sex, and index year using the LHID 2000. We analyzed the risks of heart failure using Cox proportional-hazards regression models. RESULTS During the mean follow-up of 7.1 ± 3.5 years, the cumulative incidence of heart failure was 2.24% higher in the osteoporosis cohort than in the comparison cohort (p < .001). The overall incidence of heart failure was 10.3 versus 7.62 per 1000 person-years in osteoporosis patients and controls, respectively, with an adjusted HR of 1.13 (95% CI = 1.06-1.21). CONCLUSION We observed a higher incidence of developing heart failure in Taiwanese adults with osteoporosis, especially in those with chronic comorbidities. There might be linking pathophysiology and mechanisms from osteoporosis to heart failure.
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Affiliation(s)
- Chiung-Zuan Chiu
- a School of Medicine , Fu-Jen Catholic University , New Taipei , Taiwan
- b Division of Cardiology , Shin-Kong Wu Ho-Su Memorial Hospital , Taipei , Taiwan
| | - Jiann-Horng Yeh
- a School of Medicine , Fu-Jen Catholic University , New Taipei , Taiwan
- c Division of Neurology , Shin-Kong Wu Ho-Su Memorial Hospital , Taipei , Taiwan
| | - Kou-Gi Shyu
- b Division of Cardiology , Shin-Kong Wu Ho-Su Memorial Hospital , Taipei , Taiwan
| | - Sheng-Mou Hou
- d Division of Orthopedics , Shin-Kong Wu Ho-Su Memorial Hospital , Taipei , Taiwan
| | - Cheng-Li Lin
- e Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
- f College of Medicine , China Medical University , Taichung , Taiwan
| | - Ji-An Liang
- g Department of Radiation Oncology , China Medical University Hospital , Taichung , Taiwan
- h Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine , China Medical University , Taichung , Taiwan
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22
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Veronese N, Stubbs B, Crepaldi G, Solmi M, Cooper C, Harvey NCW, Reginster JY, Rizzoli R, Civitelli R, Schofield P, Maggi S, Lamb SE. Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Bone Miner Res 2017; 32:1126-1135. [PMID: 28138982 PMCID: PMC5417361 DOI: 10.1002/jbmr.3089] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/21/2017] [Accepted: 01/27/2017] [Indexed: 12/15/2022]
Abstract
An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and meta-analysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to August 1, 2016, for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures. The association between low BMD, fractures, and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs) ±95% confidence intervals (CIs) with a random-effects meta-analysis. Twenty-eight studies (18 regarding BMD and 10 fractures) followed a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow-up (11 studies; HR = 1.33; 95%CI, 1.27 to 1.38; I2 = 53%), after adjusting for a median of eight confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR = 1.16; 95% CI, 1.09 to 1.24; I2 = 69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR = 1.20; 95% CI, 1.06 to 1.37; I2 = 91%). Regarding specific CVDs, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD-associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, UK
| | - Gaetano Crepaldi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
- National Health Care System, Padova Local Unit ULSS 17, Italy
| | - Cyrus Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of oxford, Windmill Road, Oxford, OX3 7LD, UK
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Nicolas CW Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liege, CHU Sart Tilman B23, 4000, Liège, Belgium
| | - Renè Rizzoli
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Roberto Civitelli
- Department of Medicine, Division of Bone and Mineral Diseases, Musculoskeletal Research Center, Washington University, St Louis, MO, USA
| | - Patricia Schofield
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Sarah E. Lamb
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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23
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Verheyen N, Fahrleitner-Pammer A, Belyavskiy E, Gruebler MR, Dimai HP, Amrein K, Ablasser K, Martensen J, Catena C, Pieske-Kraigher E, Colantonio C, Voelkl J, Lang F, Alesutan I, Meinitzer A, März W, Brussee H, Pieske B, Pilz S, Tomaschitz A. Relationship between bone turnover and left ventricular function in primary hyperparathyroidism: The EPATH trial. PLoS One 2017; 12:e0173799. [PMID: 28406904 PMCID: PMC5390970 DOI: 10.1371/journal.pone.0173799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 02/26/2017] [Indexed: 02/07/2023] Open
Abstract
Observational studies suggested a link between bone disease and left ventricular (LV) dysfunction that may be pronounced in hyperparathyroid conditions. We therefore aimed to test the hypothesis that circulating markers of bone turnover correlate with LV function in a cohort of patients with primary hyperparathyroidism (pHPT). Cross-sectional data of 155 subjects with pHPT were analyzed who participated in the "Eplerenone in Primary Hyperparathyroidism" (EPATH) Trial. Multivariate linear regression analyses with LV ejection fraction (LVEF, systolic function) or peak early transmitral filling velocity (e', diastolic function) as dependent variables and N-terminal propeptide of procollagen type 1 (P1NP), osteocalcin (OC), bone-specific alkaline phosphatase (BALP), or beta-crosslaps (CTX) as the respective independent variable were performed. Analyses were additionally adjusted for plasma parathyroid hormone, plasma calcium, age, sex, HbA1c, body mass index, mean 24-hours systolic blood pressure, smoking status, estimated glomerular filtration rate, antihypertensive treatment, osteoporosis treatment, 25-hydroxy vitamin D and N-terminal pro-brain B-type natriuretic peptide. Independent relationships were observed between P1NP and LVEF (adjusted β-coefficient = 0.201, P = 0.035) and e' (β = 0.188, P = 0.042), respectively. OC (β = 0.192, P = 0.039) and BALP (β = 0.198, P = 0.030) were each independently related with e'. CTX showed no correlations with LVEF or e'. In conclusion, high bone formation markers were independently and paradoxically related with better LV diastolic and, partly, better systolic function, in the setting of pHPT. Potentially cardio-protective properties of stimulated bone formation in the context of hyperparathyroidism should be explored in future studies.
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Affiliation(s)
- Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Evgeny Belyavskiy
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Martin R. Gruebler
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Hans Peter Dimai
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Klemens Ablasser
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Johann Martensen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Elisabeth Pieske-Kraigher
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Jakob Voelkl
- Department of Physiology, University of Tübingen, Tübingen, Germany
| | - Florian Lang
- Department of Physiology, University of Tübingen, Tübingen, Germany
| | - Ioana Alesutan
- Department of Physiology, University of Tübingen, Tübingen, Germany
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Synlab Academy, Synlab Services LLC, Mannheim, Germany
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim, Germany
| | - Helmut Brussee
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Burkert Pieske
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
- Department of Health Sciences and the EMGO Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim, Germany
- Specialist Clinic for Rehabilitation Bad Gleichenberg, Bad Gleichenberg, Austria
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24
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Fohtung RB, Brown DL, Koh WJH, Bartz TM, Carbone LD, Civitelli R, Stein PK, Chaves PHM, Kestenbaum BR, Kizer JR. Bone Mineral Density and Risk of Heart Failure in Older Adults: The Cardiovascular Health Study. J Am Heart Assoc 2017; 6:e004344. [PMID: 28288973 PMCID: PMC5523996 DOI: 10.1161/jaha.116.004344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/17/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (BMD) and heart failure (HF) risk remains insufficiently studied. METHODS AND RESULTS We investigated whether BMD measured by dual-energy x-ray absorptiometry was associated with incident HF in an older cohort. Cox models were stratified by sex and interactions of BMD with race assessed. BMD was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55% women) developed HF during the median follow-up of 10.5 years. In both black and nonblack women, neither total hip nor femoral neck BMD was significantly associated with HF; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck, BMD was significantly associated with HF, with evidence of an interaction by race. In nonblack men, lower total hip BMD was associated with higher HF risk (hazard ratio, 1.13 [95% CI, 1.01-1.26] per 0.1 g/cm2 decrement), whereas in black men, lower total hip BMD was associated with lower HF risk (hazard ratio, 0.74 [95% CI, 0.59-0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher HF risk (hazard ratio, 2.83 [95% CI, 1.39-5.74]) compared with normal BMD. CONCLUSIONS Among older adults, lower total hip BMD was associated with higher HF risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.
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Affiliation(s)
- Raymond B Fohtung
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - David L Brown
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - William J H Koh
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Laura D Carbone
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA
- Charlie Norwood Veterans Affairs, Augusta, GA
| | - Roberto Civitelli
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Phyllis K Stein
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Department of Medicine, Family Medicine, and Community Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Bryan R Kestenbaum
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jorge R Kizer
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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25
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Wang RT, Li XS, Zhang JR, Sun Y, Yu KJ, Liu T. Bone mineral density is associated with left ventricular diastolic function in women. Clin Cardiol 2016; 39:709-714. [PMID: 27716992 DOI: 10.1002/clc.22592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Low bone mineral density (BMD) and left ventricular (LV) diastolic function are associated with heart failure. However, little is known about the association between BMD and LV diastolic function. HYPOTHESIS BMD is independently related to LV diastolic function in women. METHODS We conducted a cross-sectional study of 432 women. Brachial-ankle pulse wave velocity (baPWV) and BMD measurements were performed. LV diastolic function and structure were assessed by echocardiographic examination. RESULTS BaPWV and the percentage of LV diastolic dysfunction increased with progressive bone loss. Moreover, partial correlation analysis demonstrated that BMD at spine L2-4 and at femoral neck were correlated with baPWV and LV diastolic function parameters after adjusting covariates. Multivariate logistic regression analysis revealed that osteoporosis was independently associated with LV diastolic dysfunction in women. CONCLUSIONS Osteoporosis is independently associated with LV diastolic dysfunction in women. A prospective study is needed to elucidate the effects of BMD on cardiac function in women.
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Affiliation(s)
- Rui-Tao Wang
- Department of Internal Medicine, Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xue-Song Li
- Department of Orthopedics, First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ji-Rong Zhang
- Department of Geriatrics, Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuxiang Sun
- Children's Nutrition Research Center, Huffington Center on Aging, Departments of Pediatrics & Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Kai-Jiang Yu
- Department of Intensive Care, Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Tiemin Liu
- Division of Hypothalamic Research, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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26
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Wacker MJ, Touchberry CD, Silswal N, Brotto L, Elmore CJ, Bonewald LF, Andresen J, Brotto M. Skeletal Muscle, but not Cardiovascular Function, Is Altered in a Mouse Model of Autosomal Recessive Hypophosphatemic Rickets. Front Physiol 2016; 7:173. [PMID: 27242547 PMCID: PMC4866514 DOI: 10.3389/fphys.2016.00173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/28/2016] [Indexed: 01/29/2023] Open
Abstract
Autosomal recessive hypophosphatemic rickets (ARHR) is a heritable disorder characterized by hypophosphatemia, osteomalacia, and poor bone development. ARHR results from inactivating mutations in the DMP1 gene with the human phenotype being recapitulated in the Dmp1 null mouse model which displays elevated plasma fibroblast growth factor 23. While the bone phenotype has been well-characterized, it is not known what effects ARHR may also have on skeletal, cardiac, or vascular smooth muscle function, which is critical to understand in order to treat patients suffering from this condition. In this study, the extensor digitorum longus (EDL-fast-twitch muscle), soleus (SOL–slow-twitch muscle), heart, and aorta were removed from Dmp1 null mice and ex-vivo functional tests were simultaneously performed in collaboration by three different laboratories. Dmp1 null EDL and SOL muscles produced less force than wildtype muscles after normalization for physiological cross sectional area of the muscles. Both EDL and SOL muscles from Dmp1 null mice also produced less force after the addition of caffeine (which releases calcium from the sarcoplasmic reticulum) which may indicate problems in excitation contraction coupling in these mice. While the body weights of the Dmp1 null were smaller than wildtype, the heart weight to body weight ratio was higher. However, there were no differences in pathological hypertrophic gene expression compared to wildtype and maximal force of contraction was not different indicating that there may not be cardiac pathology under the tested conditions. We did observe a decrease in the rate of force development generated by cardiac muscle in the Dmp1 null which may be related to some of the deficits observed in skeletal muscle. There were no differences observed in aortic contractions induced by PGF2α or 5-HT or in endothelium-mediated acetylcholine-induced relaxations or endothelium-independent sodium nitroprusside-induced relaxations. In summary, these results indicate that there are deficiencies in both fast twitch and slow twitch muscle fiber type contractions in this model of ARHR, while there was less of a phenotype observed in cardiac muscle, and no differences observed in aortic function. These results may help explain skeletal muscle weakness reported by some patients with osteomalacia and need to be further investigated.
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Affiliation(s)
- Michael J Wacker
- Muscle Biology Research Group, School of Medicine, University of Missouri-Kansas City Kansas City, MO, USA
| | | | - Neerupma Silswal
- Muscle Biology Research Group, School of Medicine, University of Missouri-Kansas City Kansas City, MO, USA
| | - Leticia Brotto
- Bone-Muscle Collaborative Science, College of Nursing and Health Innovation, University of Texas at Arlington Arlington, TX, USA
| | - Chris J Elmore
- Muscle Biology Research Group, School of Medicine, University of Missouri-Kansas City Kansas City, MO, USA
| | - Lynda F Bonewald
- Bone Biology Research Group, School of Dentistry, University of Missouri-Kansas City Kansas City, MO, USA
| | - Jon Andresen
- Muscle Biology Research Group, School of Medicine, University of Missouri-Kansas City Kansas City, MO, USA
| | - Marco Brotto
- Bone-Muscle Collaborative Science, College of Nursing and Health Innovation, University of Texas at Arlington Arlington, TX, USA
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27
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Wang RT, Liu HT, Zhao YL, Li N, Liu T, Kong X, Yu KJ. Bone mineral density is associated with left ventricular diastolic function in men with type 2 diabetes. DIABETES & METABOLISM 2016; 42:256-62. [PMID: 26971836 DOI: 10.1016/j.diabet.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 01/03/2023]
Abstract
AIMS Type 2 diabetes (T2DM) is associated with chronic heart failure and cardiomyopathy. Furthermore, low bone mineral density (BMD) predicts incident heart failure. Abnormal diastolic function reflects early changes in cardiac function and plays a key role in the development of heart failure. The purpose of this study was to investigate the association between BMD with left ventricular (LV) diastolic function in men with T2DM. METHODS In all, 344 men with T2DM and 331 age-matched control subjects were enrolled. BMD measurements were performed. LV diastolic function and structure were assessed by echocardiographic evaluation. RESULTS BMD was lower in men with T2DM than in controls. There were significant differences in the level of parameters reflecting cardiac structure and LV diastolic function between two groups. Moreover, LV diastolic function and structure parameters also showed significant differences as BMD reduced in T2DM group. BMD at femoral neck was correlated with LV diastolic function parameters in T2DM after adjusting for confounding factors. Multivariable logistic analysis revealed that osteopenia and osteoporosis were associated with diastolic dysfunction compared to the control in men with T2DM. However, no association between BMD and LV diastolic function was found in subjects without T2DM. CONCLUSION Osteoporosis may be an independent factor for LV diastolic dysfunction in men with T2DM. Our data suggested that early detection of abnormal BMD should warrant for early search of undetected LV diastolic dysfunction in diabetic men.
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Affiliation(s)
- R-T Wang
- Department of Intensive Care Unit, Harbin Medical University, the Third Affiliated Hospital, Harbin, Heilongjiang, China
| | - H-T Liu
- Department of Intensive Care Unit, Harbin Medical University, the Third Affiliated Hospital, Harbin, Heilongjiang, China
| | - Y-L Zhao
- Harbin Medical University (Da Qing), Harbin, Heilongjiang, China
| | - N Li
- Department of Cardiology, Harbin Medical University, the Second Affiliated Hospital, Harbin, Heilongjiang, China
| | - T Liu
- Division of Hypothalamic Research, UT Southwestern Medical Center, Department of Internal Medicine, 75390 Dallas, TX, USA
| | - X Kong
- Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, 02215 Boston, MA, USA
| | - K-J Yu
- Department of Intensive Care Unit, Harbin Medical University, the Third Affiliated Hospital, Harbin, Heilongjiang, China.
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28
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Mao SS, Li D, Luo Y, Syed YS, Budoff MJ. Application of quantitative computed tomography for assessment of trabecular bone mineral density, microarchitecture and mechanical property. Clin Imaging 2016; 40:330-8. [DOI: 10.1016/j.clinimag.2015.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/17/2015] [Accepted: 09/10/2015] [Indexed: 12/17/2022]
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29
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Pye SR, Vanderschueren D, Boonen S, Gielen E, Adams JE, Ward KA, Lee DM, Bartfai G, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Wu FC, O'Neill TW. Low heel ultrasound parameters predict mortality in men: results from the European Male Ageing Study (EMAS). Age Ageing 2015; 44:801-7. [PMID: 26162912 PMCID: PMC4547925 DOI: 10.1093/ageing/afv073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/02/2015] [Indexed: 11/24/2022] Open
Abstract
Background: low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men. Methods: men aged 40–79 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (Hologic—SAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model. Results: from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.0–1.4). Compared with those in higher quintiles (2nd–5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.1–2.3 and SOS: HR = 1.6; 95% CI = 1.2–2.2). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men.
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Affiliation(s)
- Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Steven Boonen
- Leuven University Division of Geriatric Medicine and Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Evelien Gielen
- Leuven University Division of Geriatric Medicine and Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Judith E Adams
- Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK
| | - Kate A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - David M Lee
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Santiago de Compostela University, Complejo Hospitalario, Universitario de Santiago (CHUS), A Coruña, Spain
| | - Joseph D Finn
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | | | | | - Thang S Han
- Royal Free and University College Hospital Medical School, London, UK
| | | | | | | | - Neil Pendleton
- Geriatric Medicine, Salford Royal Hospital NHS Trust, Manchester, UK
| | - Margus Punab
- United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Frederick C Wu
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
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Avitabile CM, Goldberg DJ, Zemel BS, Brodsky JL, Dodds K, Hayden-Rush C, Whitehead KK, Goldmuntz E, Rychik J, Leonard MB. Deficits in bone density and structure in children and young adults following Fontan palliation. Bone 2015; 77:12-6. [PMID: 25882907 PMCID: PMC4447577 DOI: 10.1016/j.bone.2015.04.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Survival of patients with congenital heart disease has improved such that there are now more adults than children living with these conditions. Complex single ventricle congenital heart disease requiring Fontan palliation is associated with multiple risk factors for impaired bone accrual. Bone density and structure have not been characterized in these patients. METHODS Tibia peripheral quantitative computed tomography (pQCT) was used to assess trabecular and cortical volumetric bone mineral density (vBMD), cortical dimensions, and calf muscle area in 43 Fontan participants (5-33 years old), a median of 10 years following Fontan palliation. pQCT outcomes were converted to sex- and race-specific Z-scores relative to age based on >700 healthy reference participants. Cortical dimensions and muscle area were further adjusted for tibia length. RESULTS Height Z-scores were lower in Fontan compared to reference participants (mean ± SD: -0.29 ± 1.00 vs. 0.25 ± 0.93, p < 0.001); BMI Z-scores were similar (0.16 ± 0.88 vs. 0.35 ± 1.02, p = 0.1). Fontan participants had lower trabecular vBMD Z-scores (-0.85 ± 0.96 vs. 0.01 ± 1.02, p < 0.001); cortical vBMD Z-scores were similar (-0.17 ± 0.98 vs. 0.00 ± 1.00, p = 0.27). Cortical dimensions were reduced with lower cortical area (-0.59 ± 0.84 vs. 0.00 ± 0.88, p<0.001) and periosteal circumference (-0.50 ± 0.82 vs. 0.00 ± 0.84, p < 0.001) Z-scores, compared to reference participants. Calf muscle area Z-scores were lower in the Fontan participants (-0.45 ± 0.98 vs. 0.00 ± 0.96, p = 0.003) and lower calf muscle area Z-scores were associated with smaller periosteal circumference Z-scores (R = 0.62, p < 0.001). Musculoskeletal deficits were not associated with age, Fontan characteristics, parathyroid hormone or vitamin D levels. CONCLUSIONS Children and young adults demonstrate low trabecular vBMD, cortical structure and muscle area following Fontan. Muscle deficits were associated with smaller periosteal dimensions. Future studies should determine the fracture implications of these deficits and identify interventions to promote musculoskeletal development.
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Affiliation(s)
- Catherine M Avitabile
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - David J Goldberg
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jill L Brodsky
- Mid-Hudson Medical Group, 30 Columbia Street, Poughkeepsie, NY 12601, USA
| | - Kathryn Dodds
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Christina Hayden-Rush
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Kevin K Whitehead
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Jack Rychik
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Mary B Leonard
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA; Division of Nephrology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
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Usala RL, Fernandez SJ, Mete M, Cowen L, Shara NM, Barsony J, Verbalis JG. Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in a Large US Health System Population. J Clin Endocrinol Metab 2015; 100:3021-31. [PMID: 26083821 PMCID: PMC4524991 DOI: 10.1210/jc.2015-1261] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT The significance of studies suggesting an increased risk of bone fragility fractures with hyponatremia through mechanisms of induced bone loss and increased falls has not been demonstrated in large patient populations with different types of hyponatremia. OBJECTIVE This matched case-control study evaluated the effect of hyponatremia on osteoporosis and fragility fractures in a patient population of more than 2.9 million. DESIGN, SETTING, AND PARTICIPANTS Osteoporosis (n = 30 517) and fragility fracture (n = 46 256) cases from the MedStar Health database were matched on age, sex, race, and patient record length with controls without osteoporosis (n = 30 517) and without fragility fractures (n = 46 256), respectively. Cases without matched controls or serum sodium (Na(+)) data or with Na(+) with a same-day blood glucose greater than 200 mg/dL were excluded. MAIN OUTCOME MEASURES Incidence of diagnosis of osteoporosis and fragility fractures of the upper or lower extremity, pelvis, and vertebrae were the outcome measures. RESULTS Multivariate conditional logistic regression models demonstrated that hyponatremia was associated with osteoporosis and/or fragility fractures, including chronic [osteoporosis: odds ratio (OR) 3.97, 95% confidence interval (CI) 3.59-4.39; fracture: OR 4.61, 95% CI 4.15-5.11], recent (osteoporosis: OR 3.06, 95% CI 2.81-3.33; fracture: OR 3.05, 95% CI 2.83-3.29), and combined chronic and recent hyponatremia (osteoporosis: OR 12.09, 95% CI 9.34-15.66; fracture: OR 11.21, 95% CI 8.81-14.26). Odds of osteoporosis or fragility fracture increased incrementally with categorical decrease in median serum Na(+). CONCLUSIONS These analyses support the hypothesis that hyponatremia is a risk factor for osteoporosis and fracture. Additional studies are required to evaluate whether correction of hyponatremia will improve patient outcomes.
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Affiliation(s)
- Rachel L Usala
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Stephen J Fernandez
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Mihriye Mete
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Laura Cowen
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Nawar M Shara
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Julianna Barsony
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
| | - Joseph G Verbalis
- School of Medicine and Graduate School of Arts and Sciences (R.L.U.) and Division of Endocrinology and Metabolism (L.C., J.B., J.G.V.), Georgetown University Medical Center, Washington, DC 20007; and Department of Biostatistics and Bioinformatics (S.J.F., M.M., N.M.S.), MedStar Health Research Institute, Washington, DC 20010
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32
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Pfister R, Michels G, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Inverse association between bone mineral density and risk of aortic stenosis in men and women in EPIC–Norfolk prospective study. Int J Cardiol 2015; 178:29-30. [DOI: 10.1016/j.ijcard.2014.10.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 12/22/2022]
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