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CLINICAL RESEARCH: HEART FAILURE

Fracture Risk in Men With Congestive Heart Failure

Risk Reduction With Spironolactone

Laura D. Carbone, MD, MS^_*,, Jessica D. Cross, MD^_*,, Syed H. Raza, MD^_*,, Andrew J. Bush, PhD, Robert J. Sepanski, MS, Saurabh Dhawan, MD^_*,, Bilal Q. Khan, MD^_*,, Malini Gupta, MD^_*,, Khurram Ahmad, MD^_*,, Rami N. Khouzam, MD^_*,, Dwight A. Dishmon, MD^_*,, Joseph P. Nesheiwat, MD^_*,, Mohammad A. Hajjar, MD^_*,, Waqas A. Chishti, MD^_*,, Wael Nasser, MD^_*,, Mehwish Khan, MD^_*,, Catherine R. Womack, MD^_*,, Tara Cho, BA^_*,, Ashley R. Haskin, BS^_* and Karl T. Weber, MD, FACC^,_*

^_* Department of Veterans Affairs Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee
Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.

Manuscript received December 5, 2007; revised manuscript received February 15, 2008, accepted March 4, 2008.

^_* Reprint requests and correspondence: Dr. Karl T. Weber, University of Tennessee Health Science Center, Division of Cardiovascular Diseases, 920 Madison Avenue, Suite 300, Memphis, Tennessee 38163. (Email: KTWeber{at}utmem.edu).

Objectives: The purpose of this study was to determine whether spironolactone use is associated with fractures in men with congestive heart failure (CHF).

Background: In rats with aldosteronism, spironolactone preserves skeletal strength. However, in humans, the relationship of spironolactone to fractures is not known.

Methods: The medical records of all male patients with CHF from 1999 to 2005 treated at the Veterans Affairs Medical Center, Memphis, Tennessee, were reviewed (n = 4,735). Odds ratios with 95% confidence intervals of having a fracture associated with spironolactone use were estimated using conditional logistic regression.

Results: We identified 167 cases with a single-incident fracture and matched these by age and race to 668 control subjects without fractures. After adjustment for covariates, spironolactone use was inversely associated with total fracture (odds ratio: 0.575; 95% confidence interval: 0.346 to 0.955, p = 0.0324).

Conclusions: The use of spironolactone is inversely associated with fractures in men with CHF.

Key Words: congestive heart failure • spironolactone • men • medical records

Abbreviations and Acronyms   CHF = congestive heart failure   CI = confidence interval   OR = odds ratio   RAAS = renin-angiotensin-aldosterone system

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