Background:The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.

Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66–82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74–86] vs. 72 [IQR, 62–80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers.

Conclusions:Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.

背景：骨质疏松症在慢性心力衰竭（CHF）中的临床意义仍不清楚。

方法和结果：总共有 303 名 CHF 患者（75 岁，[四分位距 (IQR) 66-82 岁]；41% 女性）接受了回顾性检查。使用双能X线骨密度仪（DEXA）测量腰椎、股骨颈和总股骨的骨矿物质密度（BMD），当3个部位的BMD<70%时诊断为骨质疏松症。青年平均百分比 (%YAM)。CHF 患者骨质疏松症的患病率为 40%。骨质疏松症患者年龄较大（79 [IQR, 74–86] vs. 72 [IQR, 62–80] 岁），包括大部分女性，步态速度较慢，体重指数较低。多变量逻辑回归分析表明，性别、BMI、步态速度、袢利尿剂的使用和不使用直接口服抗凝剂（DOAC）与骨质疏松症独立相关。Kaplan-Meier生存曲线显示，2或3处骨质疏松患者的死亡率和心力衰竭住院率高于非骨质疏松患者（风险比3.45，P<0.01）。在多变量 Cox 回归分析中，在调整预后标志物后，2 或 3 个部位的骨质疏松 BMD 是不良事件的独立预测因子。

结论：环利尿剂的使用和不使用 DOAC 与 CHF 患者的骨质疏松症独立相关。骨质疏松症是 CHF 患者预后不良的新预测指标。