title: Bone mass loss in chronic heart failure is associated with secondary hyperparathyroidism and has prognostic significance.
abstract: OBJECTIVE
  Chronic heart failure (CHF) is associated with increased risk of osteoporosis. We investigated the relationship between severity of CHF and bone loss, underlying pathophysiological mechanisms, and the prognostic significance of bone mass changes in heart failure.
  
  
  RESULTS
  Total body (TB) and femoral (F) bone mineral density (BMD), and T- and Z-scores in the femur were measured in 60 men with CHF (56 ± 11 years) and 13 age-matched men free from CHF. The composite study endpoint was death, implantation of a left ventricular assist device (LVAD), or inotrope dependency during a median 2-year follow-up. Parathyroid hormone (PTH) and vitamin D were measured in all subjects. TBBMD, FBMD, T-score, and Z-score were significantly lower in men with CHF. Their PTH levels were also significantly increased (111 ± 59 vs. 39 ± 14; P < 0.001). Patients in New York Heart Association classes III-IV compared with those in classes I-II demonstrated significantly lower TBBMD, FBMD, T-score, and Z-score, and higher PTH (136 ± 69 vs. 86 ± 31; P= 0.001). Increased PTH levels were correlated with reduced TBBMD (P = 0.003), FBMD (P = 0.002), and femur T-score (P = 0.001), reduced cardiac index (P = 0.01) and VO(2) peak (P < 0.0001), and increased wedge pressure (P = 0.001). Low TBBMD [hazard ratio (HR) 0.003, 95% confidence interval (CI) 0.00-0.58; P = 0.03] and Z-score (HR 0.56, 95% CI 0.35-0.90; P = 0.017) were associated with adverse outcome.
  
  
  CONCLUSIONS
  Secondary hyperparathyroidism and reduction in bone density occur in CHF patients and are associated with disease severity. Increased bone mass loss in CHF has prognostic significance.
authors.affiliation: 3rd Department of Cardiology, University of Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Terrovitis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Zotos
authors.forename: Elissavet
authors.initials: E
authors.lastname: Kaldara
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Diakos
authors.forename: Eleni
authors.initials: E
authors.lastname: Tseliou
authors.forename: Stella
authors.initials: S
authors.lastname: Vakrou
authors.forename: Chris
authors.initials: C
authors.lastname: Kapelios
authors.forename: Athanasios
authors.initials: A
authors.lastname: Chalazonitis
authors.forename: Serafeim
authors.initials: S
authors.lastname: Nanas
authors.forename: Savas
authors.initials: S
authors.lastname: Toumanidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kontoyannis
authors.forename: Eleni
authors.initials: E
authors.lastname: Karga
authors.forename: John
authors.initials: J
authors.lastname: Nanas
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density; D009202:Cardiomyopathies / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D016001:Confidence Intervals; D018450:Disease Progression; D006305:Health Status Indicators; D054144:Heart Failure, Diastolic / Q000150:complications / Q000473:pathology*; D006353:Heart-Assist Devices; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D010024:Osteoporosis / Q000209:etiology / Q000473:pathology*; D010101:Oxygen Consumption; D010281:Parathyroid Hormone; D011379:Prognosis; D018570:Risk Assessment; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D016277:Ventricular Function, Left; D014807:Vitamin D
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D