title: Exercise capacity independently predicts bone mineral density and proximal femoral geometry in patients with acute decompensated heart failure.
abstract: Heart failure is associated with increased risk of osteoporosis. We evaluated the prevalence and predictors of osteoporosis in hospitalized patients with ADHF using quantitative computed tomography. Osteoporosis and vertebral fracture are prevalent in patients with ADHF and exercise capacity independently predicts bone mass and femoral bone geometry.
  
  
  BACKGROUND
  Heart failure is associated with reduced bone mass and increased risk of osteoporotic fractures. However, the prevalence and predictors of osteoporosis in hospitalized patients with acute decompensated heart failure (ADHF) are not well understood.
  
  
  METHODS
  Sixty-five patients (15 postmenopausal females and 50 males) with ADHF were prospectively and consecutively enrolled. After stabilization of heart failure symptoms, quantitative computed tomography for bone mineral density (BMD) and femoral geometry as well as biochemical, echocardiographic, and cardiopulmonary exercise tests were performed.
  
  
  RESULTS
  Fifteen postmenopausal female showed a high prevalence of osteoporosis (40%) and vertebral fracture (53%). Among 50 male patients, 12% had osteoporosis and 32% had osteopenia, while vertebral fracture was found in 12%. Lumbar volumetric BMD (vBMD) was significantly lower in ischemic patients than non-ischemic patients (107.9 ± 47.5 vs. 145.4 ± 40.9 mg/cm(3), p = 0.005) in male. Exercise capacity, indicated by peak oxygen consumption (VO2), was significantly associated with lumbar vBMD (r = 0.576, p < 0.001) and total hip areal BMD (aBMD) (r = 0.512, p = 0.001) and cortical thickness of the femur neck (r = 0.544, p = 0.001). When controlled for age, body mass index, N-terminal proBrain natriuretic protein (NT-proBNP), etiology of heart failure, hemoglobin, and thigh circumference, multivariate regression analysis revealed peak VO2 independently predicted lumbar vBMD (β = 0.448, p = 0.031), total hip aBMD (β = 0.547, p = 0.021), and cortical thickness of the femur neck (β = 0.590, p = 0.011).
  
  
  CONCLUSIONS
  In male patients with ADHF, osteoporosis and vertebral fracture are prevalent, and exercise capacity independently predicts bone mass and geometry. Given that heart failure patients with reduced exercise capacity carry a substantial increased risk of fracture, proper osteoporosis evaluation is important in these patients.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: J-C
authors.initials: JC
authors.lastname: Youn
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
authors.forename: H S
authors.initials: HS
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Oh
authors.forename: N
authors.initials: N
authors.lastname: Hong
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.forename: S-H
authors.initials: SH
authors.lastname: Lee
authors.forename: D
authors.initials: D
authors.lastname: Choi
authors.forename: Y
authors.initials: Y
authors.lastname: Rhee
authors.forename: S-M
authors.initials: SM
authors.lastname: Kang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry / Q000379:methods; D015519:Bone Density / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005260:Female; D005269:Femur / Q000473:pathology*; D005272:Femur Neck / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D014057:Tomography, X-Ray Computed