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Patients newly diagnosed with heart failure have a four-fold higher risk of orthopedic fractures than patients with other cardiovascular conditions, according to study findings.

The risk of hip fractures is increased even more, the investigators report today in an early online release by the journal Circulation, scheduled for print publication on November 4.

Senior author Dr. Justin A. Ezekowitz and associates at the University of Alberta in Edmonton note that heart failure patients are subject to many risk factors for osteoporosis and fracture, including elevated aldosterone and parathyroid hormone levels, low vitamin D levels, low bone density, and physical inactivity.

Using administrative databases maintained by Alberta Health and Wellness, Dr. Ezekowitz's team identified patients over the age of 65 with a cardiovascular diagnosis who presented to an emergency department in Alberta between April 1998 and March 2001. They excluded patients with previous hospitalizations for heart failure and those with conditions known to substantially modify fracture or fall risk.

The study cohort consisted of 2041 patients with a new diagnosis of heart failure and 14,253 cardiovascular control patients, whose diagnoses included acute MI, cardiac dysrhythmia, and angina.

In the first year after their index visit, 4.6 per cent of patients with heart failure and 1.0 per cent of control patients sustained a fracture treated in-hospital. Corresponding rates for hip fracture were 1.3 per cent and 0.1 per cent.

After controlling for age, gender, comorbidities, and medications, heart failure was associated with an adjusted odds ratio of 4.0 for any fracture and 6.3 for hip fracture.

"Only a handful of patients in our cohort were on therapeutic interventions (to prevent fracture) recommended by major guidelines," the authors note.

They emphasize that "patients with heart failure are readily identifiable and need to have better attention paid to bone mass and amelioration of fracture risk."

"Multifaceted process-of-care interventions are clearly needed."

Circulation 2008;118