Category: Calcium/Bone Disorders

Monitor: 26


Thursday, Apr 25
1:30 PM – 2:00 PM

Objective : Advanced heart failure (HF) is associated with osteoporosis. The decreased blood supply to the bones and eventual catabolic state may lead to increased bone turnover. HF medications also impact bone turn over. LVAD (Left Ventricular Assist Device) implantation helps with hemodynamic improvement in such patients and is theoretically expected to improve bone metabolism but it has not been well studied. By following bone markers, Wu et al showed that LVAD results in anabolic bone formation. This study tried to look at the impact of LVAD implantation on bone mineral density (BMD) in patients with advanced HF.

Methods : This is a retrospective chart review using a database of patients who underwent a durable LVAD placement at Advocate Christ Medical Center between 2005 and 2017. Patients who had at least 2 BMD’s with at least one BMD post LVAD implantation were included in the study. BMDs (in g/cm2) were tracked up to 5 years post LVAD BMD change was calculated. Fracture occurrence during LVAD therapy was recorded.

Results : 237 patients received LVAD implantation from the 2005 to 2017, out of which 136 ended up with heart transplant. Only 10 out of the 101 patients with LVAD met the inclusion criteria, 6 were men, median BMI was 26 kg/m2, median duration of LVAD of 33 months (mean of 25 months) and median age group of 66 years. 3 patients had BMD pre and post LVAD implantation and the others had 2 BMD post LVAD. 6 patients showed an increase in hip BMD with a median increase of 0.09 gm/cm2, this increase was significant in 2 patients only. 5 out of the 6 patients had non ischemic cardiomyopathy and 1 had ischemic cardiomyopathy. 4 out of the 10 patients showed a decrease in hip BMD, which was significant in only one patient. An Increase in BMD at the lumbar spine level was observed in 4 patients with a median increase of 0.178 gm/cm2, significant only in one patient. The other 6 patients showed a decrease in their spine BMD also significant in one patient. None of the patients sustained a fracture during the time of their LVAD.

Discussion : Our LVAD patient population who did not receive transplant is still small. BMD showed significant increase in only 2 out of 10 patients, but for the most part there was no significant change in BMD after LVAD.

Conclusion : This study is at its early beginning. Larger scale studies are needed to look at the effect of LVAD on bone health and bone density in the long run and investigate whether the underlying cause of HF (ischemic vs. non ischemic) plays a role.


Hafsa Amjed

Resident Physician - Internal Medicine

I am a simple, fun loving person who loves to spend time with family and friends.

Joumana T. Chaiban

Associate Professor of Clinical Medicine; Internal Medicine Residency Program Research Director
University of Illinois at Chicago; Advocate Christ Medical Center, Department of Internal Medicine, Endocrinology Division

Dr. Chaiban is an attending endocrinologist at UIC/Advocate Christ Medical Center. She teaches UIC/ACMC internal medicine residents as well as UIC endocrinology & metabolism fellows from UIC. She also serves as the research director for the internal medicine residency at UIC/ACMC.

Ambar Andrade

William Cotts

Shoeb Hussain