Bone Mineral Density in Chronic Heart Failure: Association with Heart Failure Phenotype and Severity

Background: Chronic heart failure (HF) is increasingly recognized as a systemic disorder associated with multiple extracardiac complications, including impaired bone health. Osteopenia and osteoporosis are frequently observed in HF patients and may contribute to increased frailty, fracture risk, morbidity, and mortality. However, limited data are available regarding bone mineral density (BMD) across different HF phenotypes and its relationship with disease severity. Material and Methods: This hospital-based cross-sectional analytical study was conducted at Government Medical College, Srinagar, between 2023 and 2025. Fifty adult male patients with chronic heart failure were enrolled. Clinical assessment included demographic characteristics, duration of HF, New York Heart Association (NYHA) functional class, history of acute decompensated heart failure (ADHF), echocardiographic evaluation, and NT-proBNP measurement. Patients were categorized into heart failure with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF). Results: The mean age of participants was 71.6 ± 9.2 years. The mean DEXA T-score was −2.12 ± 0.77. Osteopenia was present in 64% of patients, osteoporosis in 32%, and only 4% had normal BMD. Fragility fractures were documented in 16% of participants. A significant association was observed between HF phenotype and DEXA diagnosis (p = 0.001), with osteoporosis predominating in HFrEF patients (60%). T-score demonstrated strong negative correlations with NYHA functional class (ρ = −0.739, p < 0.001) and duration of heart failure (ρ = −0.795, p < 0.001). Conclusion: Reduced bone mineral density is highly prevalent among patients with chronic heart failure. Bone loss is significantly associated with heart failure phenotype and disease severity, with patients having HFrEF exhibiting the greatest skeletal impairment. Routine assessment of bone health should be considered in patients with chronic heart failure, particularly those with reduced ejection fraction and advanced disease severity, to facilitate early identification and management of osteoporosis.

Keywords: Chronic heart failure; Bone mineral density; Osteoporosis; Osteopenia; DEXA; Heart failure with reduced ejection fraction; NYHA class; Fragility fracture.