title: Bone mineral status and bone loss over time in men with chronic systolic heart failure and their clinical and hormonal determinants.
abstract: OBJECTIVE
  Bone status has not been comprehensively studied in chronic heart failure (CHF). In CHF men, we evaluated bone status, bone loss over time, and their clinical and hormonal determinants.
  
  
  RESULTS
  Bone mineral content (BMC) and bone mineral density (BMD) of arms, legs, trunk, and total body were examined using dual-energy X-ray absorptiometry in 187 men with CHF [age: 60+/-11 years, left ventricular ejection fraction (LVEF): 32+/-7%, New York Heart Association (NYHA) class (I/II/III/IV): 20/76/76/15] and in 21 age-matched male controls without CHF. Men with CHF had reduced BMD and BMC compared with controls (P < 0.05). Reduced BMD and BMC were independently determined by CHF severity (high NYHA class and impaired LVEF), reduced lean tissue mass, low serum dehydroepiandrosterone sulphate, total testosterone (TT), and estimated free testosterone (eFT) (all P < 0.05). Bone status was reassessed in 60 patients who survived >2 years from the initial evaluation. Significant bone loss over time (a reduction in BMC total > or = 1%/year) occurred in 35% of CHF men. Advanced NYHA class (P < 0.05) and reduced serum TT and eFT (P < 0.0001) at baseline predicted augmented bone loss.
  
  
  CONCLUSIONS
  In CHF men, reduced BMD and BMC constitute an element of generalized body wasting, determined mainly by advanced heart failure and androgen deficiencies. Significant bone loss over time frequently occurs in CHF men and is related to testosterone depletion and disease severity.
authors.affiliation: Cardiology Department, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland. ewa.jankowska@antro.pan.wroc.pl
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Jankowska
authors.forename: Justyna
authors.initials: J
authors.lastname: Jakubaszko
authors.forename: Aldona
authors.initials: A
authors.lastname: Cwynar
authors.forename: Jacek
authors.initials: J
authors.lastname: Majda
authors.forename: Beata
authors.initials: B
authors.lastname: Ponikowska
authors.forename: Dorota
authors.initials: D
authors.lastname: Kustrzycka-Kratochwil
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Reczuch
authors.forename: Ludmila
authors.initials: L
authors.lastname: Borodulin-Nadzieja
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D000368:Aged; D015519:Bone Density; D002908:Chronic Disease; D019314:Dehydroepiandrosterone Sulfate; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D054143:Heart Failure, Systolic / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate