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European Journal of Heart Failure 2009 11(1):28-38; doi:10.1093/eurjhf/hfn004
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Bone mineral status and bone loss over time in men with chronic systolic heart failure and their clinical and hormonal determinants

Ewa A. Jankowska1,2,*, Justyna Jakubaszko3, Aldona Cwynar1, Jacek Majda1, Beata Ponikowska4, Dorota Kustrzycka-Kratochwil1, Krzysztof Reczuch1, Ludmila Borodulin-Nadzieja4, Waldemar Banasiak1, Philip A. Poole-Wilson5 and Piotr Ponikowski1

1 Cardiology Department, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland
2 Institute of Anthropology, Polish Academy of Sciences, Wroclaw, Poland
3 Endocrinology Department, Military Hospital, Wroclaw, Poland
4 Physiology Department, Wroclaw Medical University, Poland
5 Cardiac Medicine, National Heart and Lung Institute, Imperial College London, London, UK

* Corresponding author. Tel:/Fax: +48 71 7660 250, Email: ewa.jankowska{at}antro.pan.wroc.pl


  Abstract

Aims: 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.

Methods and 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 ≥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.

Conclusion: 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.

Key Words: Chronic heart failure • Bone density • Bone loss • Anabolic hormones • Androgens

Received January 13, 2008; Revised July 3, 2008; Accepted August 19, 2008


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