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Background: The heart failure (HF)-syndrome is associated with neuro-hormonal activation, chronic kidney disease (CKD), inflammation and alterations in the phosphorus-metabolism, all of which are involved in regulation of mineral bone density. However, the role of HF as an independent factor associated with metabolic bone disease (MBD) remains unclear., Methods: HF-patients undergoing dual X-ray absorptiometry (DEXA) were matched in a 1:2 fashion against age and gender matched controls without HF, to determine the proportion of osteoporosis (T-score < -2.5). HF-status was tested against known predictors of MBD. Correlation analysis and Z-score analysis were used to assess the impact of HF on age-related bone demineralisation., Results: A total of 190 HF-patients (age = 80 ± 10 years, female = 61%) were age and gender matched to 380 controls. HF-patients had a higher proportion of osteoporosis (26 vs 17%; p  = .007). HF patients had a lower averaged mineral bone density expressed in g/cm 2 ( p  = .030), T-scores ( p  = .001) and Z-scores ( p  < .001). After adjusting for the individual osteoporosis risk-factors of the FRAX-score, difference in baseline features, kidney function and phosphorus-metabolism alterations, heart failure remained independently associated with a lower averaged T-score (Adjusted β = -0.189; p  = .017). Heart failure was associated with an accelerated age-related decline in mineral bone density ( p  = .0418). Therapies with ACE-I or ARBs and beta-blockers associated with ameliorated bone demineralisation ( p  = .023, respectively p  = .029), while loop diuretic associated with worsened bone demineralization ( p  < .001)., Conclusion: Heart failure independently associates with MBD and higher prevalence of osteoporosis. Heart failure aggravates the aged related loss in mineral bone density while treatment with neuro-hormonal blockers seemed to ameliorate this finding.