The Link Between Heart Failure, Nutrition, and Bone Fractures

By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC (CardioSmart) Taking spironolactone, a medication used to treat hypertension, may help heart failure patients avoid bone fractures, according to a new study.

In the study, Karl T. Weber, MD of the University of Tennessee Health Science Center and colleagues reviewed medical records of 4,735 men who were treated for heart failure between 1991 and 2005 at the Veterans Affairs Medical Center in Memphis. Of those, 167 suffered a bone fracture unrelated to a fall or accident during that period. When researchers matched those cases by age and race to 668 heart-failure patients who had not had a fracture, they found that men who took 25 mg a day of spironolactone for more than 6 months were half as likely to have any type of bone fracture, compared with others who did not take the drug. Although there was no reduction in risk of hip fractures, researchers theorize that preventing hip fractures with medication may require long-term use.

Bone is hard, made up of minerals like calcium, magnesium and zinc. Because calcium is often reduced in patients with heart failure, they are at increased risk for bone thinning and for fractures due to osteoporosis, explains Dr. Weber. This predisposition toward weakening bones is often a consequence of low vitamin D levels, a diet low in calcium and high in sodium, long term treatment with medications that can leach calcium from the bones, and elevated levels of the hormone aldosterone, which promotes the loss of calcium and magnesium. Spironolactone works as an aldersterone blocker, decreasing calcium loss and reducing bone breakdown.

“I’d like to see cardiologists routinely measure bone mineral density in patients with heart failure,” says Dr. Weber. “And if it’s reduced, then consider the nutritional aspects of heart failure, among other things.”

In this study, researchers were not able to account for vitamin D levels, alcohol intake, medications, and hormone levels that also influence fracture risk. Women were not included in the analysis. Large, randomized trials are needed to confirm these results.

The study results are published in the July 8th issue of the Journal of the American College of Cardiology.

Sources:

Carbone. LD et al.  Fracture Risk in Men with Congestive Heart Failure. Risk Reduction with Spironolactone.  Journal of the American College of Cardiology, 2008.

Karl T. Weber, MD, Neuton Stern Professor of Cardiovascular Medicine,
Director, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee.