Heart Failure Increases Risk of Hip, Humerus, and Wrist Fractures in Older Adults
Overview
In older adults initiating bisphosphonate therapy for osteoporosis, heart failure (HF) independently increases the risk of hip, proximal humerus, and wrist fractures by 37–48%. This elevated fracture risk persists after adjusting for multiple confounders and is consistent across sexes.
Background
Heart failure is a prevalent condition among older adults and is associated with increased osteoporosis and fracture risk beyond traditional factors such as age and comorbidities. Previous studies have suggested that HF patients have lower bone mineral density and higher fracture-related mortality. However, the mechanisms linking HF to fractures remain incompletely understood. This study evaluated the association between HF and incident fractures in a high-risk population of older adults initiating osteoporosis treatment.
Data Highlights
Fracture Site
Women Incidence (per 1000 person-years)
Men Incidence (per 1000 person-years)
Adjusted Hazard Ratio (aHR) for HF (95% CI)
Hip
6.0 (5.6–6.4)
8.4 (7.4–9.5)
1.48 (1.20–1.83)
Proximal Humerus
4.4 (4.1–4.8)
2.7 (2.2–3.4)
1.46 (1.10–1.92)
Wrist
7.1 (6.6–7.5)
3.0 (2.4–3.7)
1.37 (1.07–1.76)
Key Findings
Heart failure was independently associated with a 37–48% increased risk of hip, proximal humerus, and wrist fractures after adjustment for confounders.
Fracture incidence was higher in men than women for hip fractures but higher in women for proximal humerus and wrist fractures.
No significant interaction was found between HF status and sex regarding fracture risk.
Results remained consistent in sensitivity analyses accounting for bisphosphonate adherence and competing risk of death.
The study included a diverse population with substantial representation of Asian and Hispanic adults.
Clinical Implications
Clinicians should recognize heart failure as an independent risk factor for non-vertebral osteoporotic fractures even among patients receiving osteoporosis therapy. Comprehensive management should include fracture risk assessment, fall prevention strategies, and optimization of cardiovascular and bone health. Further research into HF-specific mechanisms may inform targeted interventions to reduce fracture burden in this population.
Conclusion
Heart failure significantly elevates the risk of hip, proximal humerus, and wrist fractures in older adults treated for osteoporosis, underscoring the need for integrated care approaches addressing both cardiovascular and skeletal health.
Related Resources & Content
Study Authors/Source/2024 -- Heart Failure as a Distinct Risk Factor for New Hip, Proximal Humerus, and Wrist Fractures in Older Adults at Elevated Risk
