{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:31:16Z","timestamp":1783405876541,"version":"3.54.6"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The trabecular bone score (TBS) indirectly estimates bone quality and predicts low-impact fractures independently of bone mineral density (BMD). However, there is still a paucity of data linking bone and heart diseases, mainly with gaps in the TBS analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this cross-sectional study, we evaluated TBS, BMD, and fractures in patients with heart failure with reduced ejection fraction (HFrEF) and in sex-, BMI- and age-matched controls, and we assessed the fracture probability using the FRAX tool, considering active search for fractures by vertebral fracture assessment (VFA) and the adjustment for the TBS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>TBS values were 1.296 \u00b1 0.14 in 85 patients (43.5% women; age 65 \u00b1 13 years) and 1.320 \u00b1 0.11 in 142 controls (<jats:italic>P<\/jats:italic> = 0.07), being reduced (&lt; 1.31) in 51.8% and 46.1% of them, respectively (<jats:italic>P<\/jats:italic> = 0.12). TBS was lower in patients than in the controls when BMD was normal (<jats:italic>P<\/jats:italic> = 0.04) and when the BMI was 15\u201337 kg\/m<jats:sup>2<\/jats:sup> (<jats:italic>P<\/jats:italic> = 0.03). Age (odds ratio [OR] 1.05; <jats:italic>P<\/jats:italic> = 0.026), albumin (OR 0.12; <jats:italic>P<\/jats:italic> = 0.046), statin use (OR 0.27; <jats:italic>P<\/jats:italic> = 0.03), and energy intake (OR 1.03; <jats:italic>P<\/jats:italic> = 0.014) were associated with reduced TBS. Fractures on VFA occurred in 42.4% of the patients, and VFA and TBS adjustment increased the fracture risk by 16%-23%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Patients with HFrEF had poor bone quality, with a better discriminating impact of the TBS assessment when BMD was normal, and BMI was suitable for densitometric analysis. Variables related to the prognosis, severity, and treatment of HFrEF were associated with reduced TBS. VFA and TBS adjustment increased fracture risk.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0293903","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T17:27:26Z","timestamp":1699032446000},"page":"e0293903","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bone quality, mineral density, and fractures in heart failure"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1029-0964","authenticated-orcid":true,"given":"Andre Luiz","family":"Canteri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana Bassan","family":"Gusmon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar Luiz","family":"Boguszewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria Zeghbi Cochenski","family":"Borba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"pone.0293903.ref001","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/jcsm.12516","article-title":"Bone in heart failure","volume":"11","author":"G Loncar","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"pone.0293903.ref002","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/eurjhf\/hfn004","article-title":"Bone mineral status and bone loss over time in men with chronic systolic heart failure and their clinical and hormonal determinants","volume":"11","author":"EA Jankowska","year":"2009","journal-title":"Eur J Heart Fail"},{"issue":"4","key":"pone.0293903.ref003","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1210\/jc.2011-3055","article-title":"Heart failure is a clinically and densitometrically independent risk factor for osteoporotic fractures: population-based cohort study of 45,509 subjects","volume":"97","author":"SR Majumdar","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0293903.ref004","article-title":"Skeletal consequences of heart failure","volume":"18","author":"F Bandeira","year":"2022","journal-title":"Womens Health (Lond)."},{"issue":"4","key":"pone.0293903.ref005","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1002\/jor.24515","article-title":"Low-trauma fracture increases 12-month incidence of cardiovascular disease for adults with cerebral palsy","volume":"38","author":"DG Whitney","year":"2020","journal-title":"J Orthop Res"},{"issue":"3","key":"pone.0293903.ref006","first-page":"201","article-title":"Screening, diagnosis and treatment of osteoporosis: a brief review","volume":"11","author":"R Bernabei","year":"2014","journal-title":"Clin Cases Miner Bone Metab"},{"key":"pone.0293903.ref007","doi-asserted-by":"crossref","first-page":"5725","DOI":"10.3390\/ijms23105725","article-title":"Bone health in children with rheumatic disorders: focus on molecular mechanisms, diagnosis, and management.","volume":"23","author":"F Di Marcello","year":"2022","journal-title":"Int. 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