Annals of Long Term Care

American Geriatrics Society Annual Meeting, Chicago, IL, April 29-May 2, 2009

American Society of Consultant Pharmacists Midyear Conference, May 7-9, 2009

POSTER

Osteoporosis, Congestive Heart Failure, and Parkinson’s Disease

Chicago, IL—In their efforts to ascertain whether a relationship between osteoporosis and congestive heart failure (CHF) exists, researchers from the University of Puerto Rico School of Medicine, San Juan, and Johns Hopkins University, Baltimore, MD, at the AGS Annual Meeting, concluded that women who do not have CHF are less likely to develop osteoporosis because of the lack of calcium demand for compensatory mechanisms required by the heart. A healthy vitamin D status also contributes to this effect.

It is known that CHF leads to inefficient heart pumping. In order to compensate, the heart will increase its rate or pump with a greater force; both methods require calcium in order to be effective. Since the calcium demand may be increased in both processes, the body may rely on greater bone resorption in order to obtain this mineral. This, in turn, may lead to lower bone mass density and more susceptibility to fractures; these measures can worsen CHF.

To assess the relationship between osteoporosis and CHF, investigators used logistic regression in a cross-sectional analysis of the Women’s Health and Aging I sample population (n=1002), after adjusting for race, history of smoking, myocardial infarction, cholesterol, body mass index, medications, diabetes mellitus, income, hypertension, vitamin D, and CHF. Osteoporosis and CHF were defined on the basis of adjudicated data, standardized clinical algorithms, medical record review, objective data, and self-report reviewed by trained clinicians to adjudicate whether disease was present. The regression analysis showed that the odds of developing osteoporosis increased by 39% (95% confidence interval [CI], 1.25-1.55; P < 0.05) in women with smoking history.

Females with high cholesterol were 33% (95% CI, 1.17-1.54; P < 0.05) more likely to have osteoporosis, along with a 26% (95% CI, 1.14-1.41; P < 0.05) increase in those with hypertension. Women who did not have CHF were 18% (95% CI, 0.72-0.92; P < 0.05) less likely to develop osteoporosis, and those who had adequate vitamin D levels decreased their risk by 18% (95% CI, 0.72-0.92; P < 0.05). Researchers presenting this poster session concluded that the implications of this study include generating a better assessment of the connection existing between CHF and osteoporosis. In so doing, physicians can provide their patients with more accurate and complete information regarding both diseases, thereby reducing the amount of patients who may feel uninformed about these impairments.

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In other osteoporosis research presented at the AGS meeting, investigators reported that there is considerable room for improvement in the prescribing of bone prophylaxis in patients with Parkinson’s disease (PD) who are at risk of falling or with risk factors for osteoporosis (OP). Researchers from the University of Cambridge and Addenbrooke’s Hospital, Cambridge, UK, undertook an audit to assess the quality of bone prophylaxis prescribing in patients with bilateral symptoms of PD. Patients with PD are at risk of falling, and thus of fracture, and the likelihood of fracture will be highest in those with bilateral symptoms who often have multiple risk factors for OP.

The notes of 98 patients attending PD clinics, or having an inpatient admission, who were identified with bilateral PD were screened for falls, fractures, OP risk factors, and prescription of bone prophylaxis.