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Hyponatremia is Associated with Increased Osteoporosis and Bone Fractures in a Large U. S. Health System Population

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Miriam Rachel Usala G1, Fernandez SJ2, Mete M2, Cowen L3, Shara NM2, Barsony J3, Verbalis JG3. J Clin Endocrinol Metab. 2015 Jun 17:jc20151261. [Epub ahead of print]


CONTEXT:The significance of studies suggesting an increased risk of bone fragility fractures with hyponatremia through mechanisms of induced bone loss and increased falls has not been demonstrated in large patient populations with different types of hyponatremia.

OBJECTIVE:This matched case-control study evaluated the effect of hyponatremia on osteoporosis and fragility fractures in a patient population of >2.9 million.

DESIGN, SETTING, AND PARTICIPANTS:Osteoporosis (n=30,517) and fragility fracture (n=46,256) cases from the MedStar Health database were matched on age, sex, race, and patient record length with controls without osteoporosis (n=30,517) and without fragility fractures (n=46,256), respectively. Cases without matched controls or serum sodium ([Na+]) data, or with [Na+] with a same day blood glucose >200 mg/dl, were excluded.

MAIN OUTCOME MEASURES:Incidence of diagnosis of osteoporosis and fragility fractures of the upper or lower extremity, pelvis, and vertebrae were the outcome measures.

RESULTS:Multivariate conditional logistic regression models demonstrated that hyponatremia was associated with osteoporosis and/or fragility fractures, including chronic (osteoporosis OR 3.97, 95% CI 3.59-4.39; fracture OR 4.61, 95% CI 4.15-5.11), recent (osteoporosis OR 3.06, 95% CI 2.81-3.33; fracture OR 3.05, 95% CI 2.83-3.29), and combined chronic and recent hyponatremia (osteoporosis OR 12.09, 95% CI 9.34-15.66; fracture OR 11.21, 95% CI 8.81-14.26). Odds of osteoporosis or fragility fracture increased incrementally with categorical decrease in median serum [Na+].

CONCLUSIONS:These analyses support the hypothesis that hyponatremia is a risk factor for osteoporosis and fracture. Additional studies are required to evaluate whether correction of hyponatremia will improve patient outcomes.