@article{3128918,
    title = "Bone mass loss in chronic heart failure is associated with secondary hyperparathyroidism and has prognostic significance",
    author = "Terrovitis, J. and Zotos, P. and Kaldara, E. and Diakos, N. and Tseliou, E. and Vakrou, S. and Kapelios, C. and Chalazonitis, A. and Nanas, S. and Toumanidis, S. and Kontoyannis, D. and Karga, E. and Nanas, J.",
    journal = "European Journal of Heart Failure",
    year = "2012",
    volume = "14",
    number = "3",
    pages = "326-332",
    doi = "10.1093/eurjhf/hfs002",
    keywords = "inotropic agent;  parathyroid hormone;  vitamin D, adipose tissue;  adult;  article;  bone density;  controlled study;  death;  disease association;  disease severity;  follow up;  heart failure;  heart index;  human;  lean body weight;  left ventricular assist device;  lung wedge pressure;  major clinical study;  male;  osteolysis;  oxygen consumption;  priority journal;  prognosis;  secondary hyperparathyroidism, Absorptiometry, Photon;  Bone Density;  Cardiomyopathies;  Case-Control Studies;  Confidence Intervals;  Disease Progression;  Health Status Indicators;  Heart Failure, Diastolic;  Heart-Assist Devices;  Humans;  Hyperparathyroidism, Secondary;  Male;  Middle Aged;  Myocardial Contraction;  Osteoporosis;  Oxygen Consumption;  Parathyroid Hormone;  Prognosis;  Risk Assessment;  Statistics as Topic;  Statistics, Nonparametric;  Stroke Volume;  Ventricular Function, Left;  Vitamin D",
    abstract = "Aims: Chronic heart failure (CHF) is associated with increased risk of osteoporosis. We investigated the relationship between severity of CHF and bone loss, underlying pathophysiological mechanisms, and the prognostic significance of bone mass changes in heart failure. Methods and results: Total body (TB) and femoral (F) bone mineral density (BMD), and T- and Z-scores in the femur were measured in 60 men with CHF (56 ± 11 years) and 13 age-matched men free from CHF. The composite study endpoint was death, implantation of a left ventricular assist device (LVAD), or inotrope dependency during a median 2-year follow-up. Parathyroid hormone (PTH) and vitamin D were measured in all subjects. TBBMD, FBMD, T-score, and Z-score were significantly lower in men with CHF. Their PTH levels were also significantly increased (111 ± 59 vs. 39 ± 14; P < 0.001). Patients in New York Heart Association classes IIIIV compared with those in classes III demonstrated significantly lower TBBMD, FBMD, T-score, and Z-score, and higher PTH (136 ± 69 vs. 86 ± 31; P = 0.001). Increased PTH levels were correlated with reduced TBBMD (P = 0.003), FBMD (P = 0.002), and femur T-score (P = 0.001), reduced cardiac index (P = 0.01) and VO 2 peak (P < 0.0001), and increased wedge pressure (P = 0.001). Low TBBMD [hazard ratio (HR) 0.003, 95% confidence interval (CI) 0.00-0.58; P = 0.03] and Z-score (HR 0.56, 95% CI 0.35-0.90; P = 0.017) were associated with adverse outcome. Conclusions: Secondary hyperparathyroidism and reduction in bone density occur in CHF patients and are associated with disease severity. Increased bone mass loss in CHF has prognostic significance. © The Author 2012."
}