Purpose

Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF.

Methods

84 patients (44 males, median age 48.5 years, range 43–65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6–12 months during the study period.

Results

At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001).

Conclusions

This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.

中文翻译：

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心力衰竭中年患者继发性甲状旁腺功能亢进症和胸椎骨折：为期3年的前瞻性研究

目的

在老年心力衰竭（HF）患者中描述了椎骨骨折（VFs），而在年轻的HF患者中其发生率和决定因素仍然未知。这项研究旨在评估继发性甲状旁腺功能亢进症（SHPT）是否可能影响中年HF患者的VF风险。

方法

在基线和36个月的随访中，对84例HF患者（男性44例，中位年龄48.5岁，范围43-65）进行了前瞻性评估，并通过胸部X射线定量形态学对其骨密度（BMD）和VF进行了评估。在研究期间，在基线以及每6至12个月评估血清PTH，钙，25-羟基维生素D和24小时尿钙。

结果

在基线时，分别在43例患者（51.2％），73例患者（86.9％）和29例患者（34.5％）中发现了SHPT，维生素D缺乏和VF。SHPT与基线时的VF相关[逆概率加权（ipw）优势比（OR）12.2，p  <0.001]。患者仅接受维生素D3（56％），维生素D3加碳酸钙（21.4％），单独骨化三醇（4.8％），双膦酸盐加维生素D3（8.3％）或双膦酸盐，维生素D3和碳酸钙（9.5）的组合治疗％）。在随访结束时，所有患者均纠正了维生素D缺乏症，而19/84例患者（22.6％）患有持续性SHPT。在随访期间，有16名患者发生了室颤，其结果与基线SHPT相关（ipw OR 55.7，p <0.001），即使从基线到随访的BMD调整后也是如此（ipw OR 46.4，p  <0.001）。

结论

这项研究提供了第一个证据，SHPT可能是中年HF患者的VF的危险因素。