Heart Failure as a Distinct Risk Factor for New Hip, Proximal Humerus, and Wrist Fractures in Older Adults at Elevated Risk
By
Amanda J. Chang
Alan S. Go
Malini Chandra
Laura D. Carbone
Howard A. Fink
Susan M. Ott
Joan C. Lo
January 26, 2026
Clinical Scorecard: Heart Failure as a Distinct Risk Factor for New Hip, Proximal Humerus, and Wrist Fractures in Older Adults at Elevated Risk
At a Glance
Category Detail
Condition Heart failure (HF) and its association with osteoporotic fractures Key Mechanisms HF increases fracture risk independent of bone mineral density and traditional osteoporosis risk factors; multifactorial mechanisms likely Target Population Older adults aged 65–84 years initiating oral bisphosphonate therapy Care Setting Outpatient and hospital settings within integrated healthcare system
Key Highlights
HF independently increases risk of hip, proximal humerus, and wrist fractures by 37–48% in older adults on osteoporosis therapy. Fracture risk elevation persists after adjusting for demographics, comorbidities, prior fractures, and bisphosphonate adherence. Study includes diverse US populations with substantial representation of Asian and Hispanic adults. Guideline-Based Recommendations
Diagnosis
Ascertain HF status using hospital and outpatient diagnoses within 5 years prior to osteoporosis therapy initiation. Evaluate fracture risk in HF patients beyond traditional osteoporosis risk factors. Management
Continue osteoporosis pharmacotherapy with bisphosphonates ensuring adherence ≥80%. Implement falls prevention strategies, nutrition optimization, smoking cessation, and lifestyle interventions in HF patients. Consider HF-specific mechanisms contributing to fracture risk for tailored management. Monitoring & Follow-up
Monitor for incident hip, proximal humerus, and wrist fractures during follow-up. Assess adherence to osteoporosis therapy regularly. Account for competing risks such as mortality in clinical follow-up. Risks
Increased fracture risk in HF patients despite osteoporosis treatment adherence. Potential underestimation of fracture burden due to lack of data on HF severity, subtype, and bone density. Patient & Prescribing Data
Older adults aged 65–84 years initiating oral bisphosphonate therapy with and without HF
HF patients have higher fracture incidence despite bisphosphonate therapy adherence, highlighting need for comprehensive fracture risk management.
Clinical Best Practices
Screen for HF in older adults initiating osteoporosis therapy to identify elevated fracture risk. Maintain high adherence to bisphosphonate therapy (≥80%) to optimize fracture prevention. Incorporate multifactorial interventions including falls prevention and lifestyle modification in HF patients. Recognize the importance of diverse populations in fracture risk assessment and management. Related Resources & Content
