Chronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center

Hoffmann, Daniel Max; Popescu, Cristian D.; Komrakova, Marina; Welte, Lena; Saul, Dominik; Lehmann, Wolfgang; Hawellek, Thelonius; Beil, Frank Timo; Dakna, Mohammed; Sehmisch, Stephan

doi:10.1016/j.bonr.2019.100234

Cited by 7 publications

(6 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another limitation of the study is that the influence of medications on sodium levels in the patient population was not considered as has been investigated in several previous studies [8,13,18,[25][26][27][28]. These studies reported, for example, that aldosterone antagonists and sartans have a significant impact on hyponatremia of patients [29] as has also been observed with selective serotonin re-uptake inhibitors (SSRIs) and thiazide, all of which induce hyponatremia [30][31][32][33][34]. This aspect concerning the influence of possible medication on hyponatremia and its subsequent effect on low-energy trauma fractures is not reflected in the results.…”

Section: Discussionmentioning

confidence: 99%

Influence of Hyponatremia on Spinal Bone Quality and Fractures Due to Low-Energy Trauma

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and Objectives: Hyponatremia is the most common electrolyte disorder in elderly and associated with increased risk of falls. Clinical studies as well as small animal experiments suggested an association between chronic hyponatremia and osteoporosis. Furthermore, it has been assumed that subtle hyponatremia may be an independent fracture risk in the elderly. Therefore, this study was designed to evaluate the possible influence of chronic hyponatremia on osteoporosis and low-energy fractures of the spine. Materials and Methods: 144 patients with a vertebral body fracture (mean age: 69.15 ± 16.08; 73 females and 71 males) due to low-energy trauma were treated in a level one trauma center within one year and were included in the study. Chronic hyponatremia was defined as serum sodium < 135 mmol/L at admission. Bone mineral density (BMD) of the spine was measured using quantitative computed tomography in each patient. Results: Overall, 19.44% (n = 28) of patients in the low-energy trauma group had hyponatremia. In the group with fractures caused by low-energy trauma, the proportion of hyponatremia of patients older than 65 years was significantly increased as compared to younger patients (p** = 0.0016). Furthermore, there was no significant gender difference in the hyponatremia group. Of 28 patients with chronic hyponatremia, all patients had decreased bone quality. Four patients showed osteopenia and the other 24 patients even showed osteoporosis. In the low-energy trauma group, the BMD correlated significantly with serum sodium (r = 0.396; p*** < 0.001). Conclusions: The results suggest that chronic hyponatremia affects bone quality. Patients with chronic hyponatremia have an increased prevalence of fractures after low-energy trauma due to a decreased bone quality. Therefore, physicians from different specialties should focus on the treatment of chronic hyponatremia to reduce the fracture rate after low-energy trauma, particularly with elderly patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Influence of Hyponatremia on Spinal Bone Quality and Fractures Due to Low-Energy Trauma

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Inclusion criteria: (i) age 60–90 years; (ii) acute OVCF (<2 weeks 29 ) from low energy trauma (fall from a standing height or less 30 , 31 ); (iii) patients suffering from severe back pain; (iv) only underwent either rhPTH or VAP treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Inclusion criteria: (i) age 60-90 years; (ii) acute OVCF (<2 weeks 29 ) from low energy trauma (fall from a standing height or less 30,31 Finally, 22 patients who received rhPTH treatment (rhPTH group) and 49 patients who underwent VAP (VAP group) were included in this study. All the patients' data were collected and measured by two experienced orthopaedic surgeons (T. Z. and G. G).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Efficacy of Recombinant Human Parathyroid Hormone versus Vertebral Augmentation Procedure on Patients with Acute Osteoporotic Vertebral Compression Fracture

Gou

Zhao

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective: Although widely used in clinical practice, vertebral augmentation procedure (VAP) for osteoporotic vertebral compression fracture (OVCF) is not supported. Recently, the effect of recombinant human parathyroid hormone (1-34) (rhPTH) has been paid great attention for its efficacy in anti-osteoporosis and bone union. This study aims to explore the outcome of rhPTH on acute OVCF and compare it with VAP to clarify its therapeutic advantages. Methods:The retrospective study comprised 71 acute OVCF patients from January 2015 to March 2020: 22 received rhPTH treatment (rhPTH group) and 49 underwent VAP (VAP group). The rhPTH group was 15 women and seven men with an average of 76.18 years, and the VAP group were 35 women and 14 men with an average of 73.63 years. The thoracic/lumbar vertebrae were 14/8 in the rhPTH group and 29/20 in the VAP group. The average follow-up period was 14.05 months in the rhPTH group and 13.82 months in the VAP group. The two groups were assessed regarding the visual analog score (VAS), Oswestry Disability Index (ODI), OVCF bone union, bone mineral density (BMD), kyphotic angle (KA), anterior and posterior border height (ABH and PBH, respectively), adverse events and the health-related quality of life assessed by short form-36 health survey scores (SF-36). Categorical variables were analyzed by chisquare test and continuous variables between groups were analyzed by independent samples t-test or Mann-Whitney U test according to the normality.Results: During the follow-up, the VAS was significantly lower in the rhPTH group than in the VAP group at month 3 (0.39 AE 0.6 vs 0.68 AE 0.651) (p = 0.047), month 6 (0.45 AE 0.60 vs 2.18 AE 1.22) (p < 0.001), and month 12 (0.45 AE 0.60 vs 2.43 AE 1.49) (p < 0.001). At month 12, the ODI was significantly lower in the rhPTH group (18.59 AE 3.33%) than in the VAP group (28.93 AE 16.71%) (p < 0.001). Bone bridge was detected on sagittal computed tomography images of all fractured vertebrae in the rhPTH group. The BMD was significantly higher in the rhPTH group (87.66 AE 5.91 Hounsfield units [HU]) than in the VAP group (68.15 AE 11.32HU) (p < 0.001). There were no significant differences in the changes in KA, ABH, and PBH between groups (all p > 0.05). The incidence of new OVCF was significantly lower in the rhPTH group than in the VAP group (p = 0.042). All scores of SF-36 were significantly higher in the rhPTH group than in the VAP group (all p < 0.05). Conclusion:In acute OVCF patients, rhPTH was better than VAP in increasing spinal BMD to promote OVCF healing, reduce new OVCF, and improve back pain, physical ability, and health-related quality of life.

show abstract

“…I nstitutional review board approval was obtained to perform a retrospective review of clinical registry data for patients undergoing TJA (total hip or knee arthroplasty) at a large, tertiary academic institution between 2016 and 2019. Consecutive patients undergoing TJA who had preoperative and postoperative serum sodium concentration data, among other a priori-determined variables of interest based on prior literature, were deemed eligible for inclusion (Table I) 1,[16][17][18] . Preoperative sodium levels were measured within 1 week of surgery, while postoperative levels were measured within 24 hours of surgery.…”

Section: Patient Selectionmentioning

confidence: 99%

Development and Internal Validation of Machine Learning Algorithms for Predicting Hyponatremia After TJA

Kunze

Sculco

Zhong

et al. 2021

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: The development of hyponatremia after total joint arthroplasty (TJA) may lead to several adverse events and is associated with prolonged inpatient length of stay as well as increased hospital costs. The purpose of this study was to develop and internally validate machine learning algorithms for predicting hyponatremia after TJA.Methods: A consecutive cohort of 30,703 TJA patients from an institutional registry at a large, tertiary academic hospital were included. A total of 19 potential predictor variables were collected. Hyponatremia was defined as a serum sodium concentration of <135 mEq/L. Five machine learning algorithms were developed using a training set and internally validated using an independent testing set. Algorithm performance was evaluated through discrimination, calibration, decision-curve analysis, and Brier score.Results: The charts of 30,703 patients undergoing TJA were reviewed. Of those patients, 5,480 (17.8%) developed hyponatremia postoperatively. A combination of 6 variables were demonstrated to optimize algorithm prediction: preoperative serum sodium concentration, age, intraoperative blood loss, procedure time, body mass index (BMI), and American Society of Anesthesiologists (ASA) score. Threshold values that were associated with greater hyponatremia risk were a preoperative serum sodium concentration of £138 mEq/L, an age of ‡73 years, an ASA score of >2, intraoperative blood loss of >407 mL, a BMI of £26 kg/m 2 , and a procedure time of >111 minutes. The stochastic gradient boosting (SGB) algorithm demonstrated the best performance (c-statistic: 0.75, calibration intercept: 20.02, calibration slope: 1.02, and Brier score: 0.12). This algorithm was turned into a tool that can provide real-time predictions (https:// orthoapps.shinyapps.io/Hyponatremia_TJA/). Conclusions:The SGB algorithm demonstrated the best performance for predicting hyponatremia after TJA. The most important factors for predicting hyponatremia were preoperative serum sodium concentration, age, intraoperative blood loss, procedure time, BMI, and ASA score. A real-time hyponatremia risk calculator was developed, but it is imperative to perform external validation of this model prior to using this calculator in clinical practice.

show abstract

Chronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center

Cited by 7 publications

References 43 publications

Influence of Hyponatremia on Spinal Bone Quality and Fractures Due to Low-Energy Trauma

Influence of Hyponatremia on Spinal Bone Quality and Fractures Due to Low-Energy Trauma

Efficacy of Recombinant Human Parathyroid Hormone versus Vertebral Augmentation Procedure on Patients with Acute Osteoporotic Vertebral Compression Fracture

Development and Internal Validation of Machine Learning Algorithms for Predicting Hyponatremia After TJA

Contact Info

Product

Resources

About