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Review
. 2022 Jan-Dec:18:17455057221135501.
doi: 10.1177/17455057221135501.

Skeletal consequences of heart failure

Francisco Bandeira  1 , Lucian Batista de Oliveira  1 , Rodrigo Botelho Caldeira  1 , Leticia Saldanha Toscano  1
Affiliations
Review

Skeletal consequences of heart failure

Francisco Bandeira et al. Womens Health (Lond). 2022 Jan-Dec.

Abstract

Heart failure (HF) is a prevalent clinical syndrome that causes significant physical limitations. Osteoporosis is also an important cause of loss of functionality, and it mainly affects women. There are several reports linking HF and osteoporosis, and both share risk factors. Most of the data available so far point to bone fragility as a consequence of HF, and several mechanisms have been identified to explain this relationship. Among the proposed pathophysiological mechanisms are the hyperactivation of the renin-angiotensin-aldosterone system and the increase in parathyroid hormone, functional limitation, production of inflammatory mediators and the use of drugs for HF. The role of osteoprotegerin has gained attention owing to its cardiovascular and skeletal effects, its observed deficiency during the postmenopausal period along with its compensatory increases in HF and severe osteoporosis. The objective of this review was to perform a literature search for the main evidence on skeletal impairment in HF, with emphasis on women. As for epidemiological studies, we selected data from 3 meta-analyses and 20 individual observational studies, which together showed the interrelationship between the two clinical conditions in terms of both decreased bone density and increased fracture risk. In conclusion, HF and osteoporosis are interrelated conditions mediated by complex pathophysiological mechanisms which may be more relevant for postmenopausal women, considered to be a vulnerable population for both cardiovascular diseases and bone fragility.

Keywords: bone; bone diseases; fractures; heart; heart failure; metabolic; osteoporosis.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Potential pathophysiological mechanisms for bone involvement in HF. Ca: calcium; CVD: cardiovascular disease; IL-6: interleukine-6; Mg: magnesium; OPG: osteoprotegerin; PTH: parathyroid hormone; TNF-α: tumour necrosis factor alpha.
See this image and copyright information in PMC

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