Key result
Heart failure is linked to higher hip fracture risk, largely explained by shared risk factors.
Why the study?
Increasing survival rates in heart failure place patients at risk for diseases of ageing such as osteoporosis, but the epidemiology of hip fractures in heart failure was unknown.
Is heart failure associated with an increased risk of hip fractures and subsequent mortality?
Cohort (n=5,613)
Is heart failure associated with an increased risk of hip fractures and subsequent mortality?
Effect estimate: adjusted HR 1.59 (men), 1.41 (women) (95% CI 0.93-2.72 (men), 0.98-2.03 (women))
Absolute Event Rate: 14% vs 6.8%
Patients with heart failure have a higher incidence of hip fractures, which substantially increases mortality, though much of the association is driven by shared risk factors.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This intersection is important because orthopedic fracture, especially hip fracture, is very debilitating. On top of a very debilitating disease such as heart failure, this is a very big problem.”
“Our study demonstrates for the first time that heart failure and thinning of bones go hand in hand. Understanding the mechanism between heart failure and osteoporosis might lead to new treatments for both conditions.”
“As the population ages, two of the most prevalent diseases are heart disease and osteoporosis. While hip fractures are the most devastating complication of osteoporosis, vertebral compression fractures are by far the most common. Unfortunately, 60 percent to 70 percent of spinal fractures are initially asymptomatic, escaping clinical detection yet placing the patients at higher risk for another vertebral fracture and subsequent hip fractures.”
Shared risk factors largely mediate the HF-hip fracture link; leaves open whether HF-specific pathways merit targeted investigation.
AIMS: The aim of the study was to find the epidemiology of hip fractures in heart failure. The increasing survival rate for patients with heart failure places them at risk for other diseases of ageing, including osteoporosis. METHODS AND RESULTS: We included 5613 persons from the Cardiovascular Health Study (CHS) with an average of 11.5 year follow-up. We determined incidence rates and hazard ratios (HRs) in persons with heart failure compared with persons without heart failure and mortality hazards following these fractures. Annualized incidence rates for hip fractures were 14 per 1000 person-years in heart failure and 6.8 per 1000 person-years without heart failure. Unadjusted and multivariable adjusted HRs for hip fracture associated with heart failure in men were 1.87 (95% CI 1.2-2.93) and 1.59 (95% CI 0.93-2.72), respectively. Respective HRs for women were 1.75 (95% CI 1.27-2.4) and 1.41 (95% CI 0.98-2.03). Mortality hazard was approximately 2-fold greater in patients with heart failure and hip fracture compared with those having heart failure alone. CONCLUSION: Persons with heart failure are at high risk for hip fractures. However, much of the association between hip fractures and heart failure is explained by shared risk factors. Hip fractures are a substantial contributor to mortality in men and women with heart failure.
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Carbone et al. (2009) conducted a cohort in Heart failure (n=5,613). Heart failure vs. No heart failure was evaluated on Hip fractures (adjusted HR 1.59 (men), 1.41 (women), 95% CI 0.93-2.72 (men), 0.98-2.03 (women)). Heart failure was associated with a higher incidence of hip fractures compared to no heart failure (14 vs 6.8 per 1000 person-years), but much of the association is explained by shared risk factors.
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