Purpose Emerging data implicate an important interrelationship between cardiovascular disease and osteoporosis. Data from our institution extend this finding to include a linkage between congestive heart failure (CHF) and osteoporosis and suggest that disturbances in the vitamin D/parathyroid axis, particularly in African Americans (AA), may play a pivotal role in the pathogenesis of both CHF and bone loss. However, little is known about the epidemiology of osteoporotic-related fractures that occur in the setting of CHF.
Methods The medical records review of all male patients with a diagnosis of CHF and hip fractures hospitalized at Veterans Administration Medical Center, Memphis, TN, between 1999 and 2005 were reviewed to determine characteristics of these fractures and subsequent treatment for osteoporosis. The protocol was approved by the Institutional Review Board at the VA Medical Center, Memphis, TN.
Results 3,424 patients with an ICD-9 diagnosis of CHF between January 1999 and July 2005 were identified; of these 86 had an ICD-9 diagnosis of hip fracture (not pathological). Fifty patients were excluded for the following reasons: female (n = 2); hip fracture was traumatic (n = 2); no record of hip fracture (n = 9) or record of CHF (n = 4) noted in chart; insufficient information available concerning hip fracture (n = 4); cancer (n = 29). This left a study population of 36 individuals, none of whom had any condition known to affect bone metabolism. The mean age of these male veterans with hip fractures was 69 (range 47-87); 25% of these fractures occurred in AA. Nineteen percent of these veterans had at least two atraumatic fractures during the time period of this study; in 6%, this second fracture was a contralateral hip fracture. Hip fracture location was approximately equally divided between femoral neck and intertrochanteric fractures. During the time period of this study, following their hip fracture, only three patients had a DXA or QCT scan measured, and in only one patient was therapy with a bisphosphonate or teriparatide initiated.
Conclusions Hip fractures in male veterans with CHF occur in both AA and Caucasians and are seriously underrecognized as a marker for osteoporosis and future fractures. Treatment to prevent future fractures in these patients needs to be adequately addressed.
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