Key result
Adults with moderate or complex congenital heart disease had reduced skeletal strength in the tibia (xSSI 1492 vs 1780 mm3, p<0.001) and radius compared to controls, despite normal bone mineral density.
Why the study?
Bone mineral density and skeletal strength needed to be evaluated in the growing population of adults with moderate or complex congenital heart disease.
Do adults with moderate or complex congenital heart disease have reduced bone mineral density and skeletal strength compared to matched controls?
Case-Control (n=98)
Do adults with moderate or complex congenital heart disease have reduced bone mineral density and skeletal strength compared to matched controls?
Absolute Event Rate: 1492% vs 1780%
p-value: p=< 0.001
Adults with moderate or complex congenital heart disease exhibit reduced skeletal strength despite normal bone mineral density, potentially increasing their risk of future fractures.
May indicate elevated fracture risk in moderate/complex CHD despite normal BMD; hypothesis-generating for targeted skeletal assessment.
We aimed to study bone mineral density (BMD) and skeletal strength in the growing population of adults with moderate or complex congenital heart disease (CHD). Peripheral quantitative computed tomography (pQCT) was performed on the radius and tibia in 49 adults with moderate or complex CHD, and in 49 age and sex matched controls (n = 23 [47%] female, mean age 36 ± 15.5 years.) Strength in the radius and tibia were presented, respectively, in terms of Strength-Strain Index (SSI). Patients had similar total BMD as controls in both the radius (807 ± 82 vs. 792 ± 75 mg/cm3, p = 0.3) and tibia (663 ± 86 vs. 689 ± 67 mg/cm3, p = 0.1). In the radius, patients had a lower xSSI than controls (154 ± 46 vs. 175 ± 54 mm3, p = 0.04) but a similar ySSI (178 ± 58 vs. 195 ± 55 mm3, p = 0.1). In the tibia, patients had a lower xSSI (1492 ± 399 vs. 1780 ± 372 mm3, p < 0.001) as well as ySSI (1066 ± 304 vs. 1250 ± 281, p = 0.002). In a multiple linear regression model, only height was independently associated with decreased skeletal strength in patients tibia in terms of xSSI [F(2,46) = 40.002, p < 0.001, R2 = 0.635]. Adults with moderate or complex CHD had reduced strength in the radius and tibia, despite a normal BMD as assessed with pQCT. Their reduced bone strength could increase the risk of future fractures.
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Johansson et al. (2021) conducted a case-control in Moderate or complex congenital heart disease (n=98). Moderate or complex congenital heart disease vs. Age and sex matched controls was evaluated on Skeletal strength in the tibia (xSSI) (p=< 0.001). Adults with moderate or complex congenital heart disease had reduced skeletal strength in the tibia (xSSI 1492 vs 1780 mm3, p<0.001) and radius compared to controls, despite normal bone mineral density.
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