It's not clear why heart failure should lead to weaker bones, Ezekowitz said. One theory is that the diuretic drugs often prescribed for people with heart failure might be bad for the bones, he said. Another possibility is the higher level of parathyroid hormone, which handles calcium and magnesium, often seen in heart failure could have a bone-weakening effect.
Physicians treating people for heart failure need to be more aware of the risk of fractures, said Dr. Mariell L. Jessup, director of the heart failure and transplant program at the University of Pennsylvania and a spokeswoman for the American Heart Association.
"When patients have such a severe disease, we tend to ignore the other problems they might have," Jessup said. "There is good reason to focus on the total patient, and not just their heart failure."
Awareness of the vitamin D status of someone with heart failure is important, both Jessup and Ezekowitz said. Vitamin D is directly involved in bone strength. But both expressed doubts about using vitamin D supplements specifically for heart failure patients.
"People should be on vitamin D supplements according to the guidelines for osteoporosis care," Ezekowitz said. "There haven't been a lot of clinical trials testing vitamin D supplements in heart failure patients."
Asked about vitamin D, Jessup said, "I treat heart disease. I leave that question to the endocrinologists."
Heart failure is described by the American Heart Association.
SOURCES: Justin A. Ezekowitz, director, Heart Function Clinic, assistant professor, medicine, University of Alberta, Edmonton, Canada; Mariell L. Jessup, professor, medicine, and director, heart failure and transplant program, University of Pennsylvania, Philadelphia; Nov. 4, 2008, Circulati
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