Markers of osteosarcopenia predicting outcomes in chronic heart failure: a prospective cohort study
K Ablasser, N Schwegel, V Hoeller, V Santner, E Kolesnik, J Schmid, S Pilz, B Obermayer-Pietsch, A Zirlik, D Von Lewinski, N VerheyenAbstract
Background/Introduction
Comorbidities such as osteoporosis and sarcopenia are common in chronic heart failure (HF) and worsen prognosis. The combined syndrome osteosarcopenia—concurrent bone disease and muscle impairment—may provide incremental prognostic information. Simple functional tests and bone turnover markers could help identify HF patients at elevated risk of death or worsening HF (WHF) hospitalization.
Purpose
To evaluate whether markers of osteosarcopenia, including DEXA scans, gait speed, hand grip strength,and bone turnover biomarkers are associated with 5-year outcomes in patients with chronic HF and reduced LVEF.
Methods
Prospective single-center cohort of 205 symptomatic, stable HF patients (LVEF <40%) on guideline therapy. Osteoporosis was defined by DXA T-score ≤ −2.5; vertebral fractures by Genant semiquantitative scoring. Baseline serum/urine bone markers included osteocalcin, P1NP, TRAP, and CTX. Functional tests: gait speed over 6 m and hand grip strength (three attempts per hand; best value). Collected baseline demographics including BMI 28.7 ± 5.16 and BSA 2.00 ± 0.21. Outcomes—all-cause mortality, cardiovascular mortality, and WHF hospitalizations—were adjudicated over 5 years.
Results
Median age 66 years; median LVEF 37%; NT-proBNP 964 pg/mL. Osteoporosis or vertebral fractures occurred in 27%. Mean biomarkers: osteocalcin 24.1 µg/L; P1NP 50.0 µg/L; TRAP 2.2 U/L; CTX 0.40 pg/mL. Mean gait time 4.61 ± 1.37 s; hand grip right 28.99 ± 11.34 kg, left 28.13 ± 11.94 kg. Higher baseline P1NP was associated with cardiovascular death (57.0 ± 5.4 vs 47.2 ± 2.0; p<0.05). Elevated osteocalcin predicted the composite of cardiovascular death or WHF hospitalization (27.6 ± 3.4 vs 23.0 ± 1.0; p<0.05). TRAP and CTX showed no outcome associations. Slower gait speed correlated strongly with all-cause death and WHF hospitalizations. Osteocalcin correlated with slower gait and lower grip strength, linking bone turnover to impaired muscle function. Patients with combined bone disease and reduced muscle function had the highest event rates.
Conclusion
Osteosarcopenia is common in HF with reduced LVEF and predicts adverse 5-year outcomes. Bone markers (P1NP, osteocalcin) and simple functional measures (gait speed, hand grip) provide complementary prognostic information and may improve risk stratification and guide multidisciplinary interventions.