Chronic prolonged hyponatremia and risk of hip fracture in elderly patients with chronic kidney disease

Nigwekar, Sagar U.; Negri, Armando; Bajpai, Divya; Allegretti, Andrew S.; Kalim, Sahir; Seethapathy, Harish; Bhan, Ishir; Murthy, K. Krishna; Ayus, Juan Carlos

doi:10.1016/j.bone.2019.07.029

Cited by 14 publications

(25 citation statements)

References 33 publications

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“…Such conditions were not considered in the study since the first sodium measurement was taken only on the day of admission and followed up only during the usually short hospital stay. Nevertheless, the results of the present study are in line with earlier reports, suggesting that chronic hyponatremia is an important determinant of fracture risk [15,20].…”

Section: Discussionsupporting

confidence: 93%

“…The study establishes that chronic hyponatremia is highly prevalent in patients with fractures due to a low-energy trauma. This correlation has been suggested by earlier studies [8,13,[18][19][20] showing that elderly patients with hyponatremia are susceptible to fragility fractures. Chronic hyponatremia in about one-fifth (19.44%) of the patients who experienced a low-energy trauma was observed, while no hyponatremia patients were found within the high-energy trauma control group.…”

Section: Discussionsupporting

confidence: 74%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 74%

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

et al. 2021

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“…Our data confirm findings of previous studies that hyponatremia is highly prevalent in patients with fractures due to low energy trauma (Cumming et al, 2014; Gankam Kengne et al, 2008; Sandhu et al, 2009; Kwak et al, 2015; Nigwekar et al, 2019). Overall, we found hyponatremia in 15.6% of patients after low energy trauma compared with 2–4% in the general population, and no case of hyponatremia in the control group with high energy trauma (Mohan et al, 2013; Mohan et al, 2013).…”

Section: Discussionsupporting

confidence: 92%

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

Hoffmann¹,

Popescu²,

Komrakova³

et al. 2020

Bone Reports

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IntroductionWe evaluated the prevalence and influence of chronic hyponatremia in patients with low energy trauma. We also investigated the influence of medication and diseases on hyponatremia.Material and methodsThis retrospective study included 314 cases of proximal femoral fracture due to low energy trauma. Patients were treated in the University Medical Center Goettingen within 3 years. Hyponatremia was defined as serum sodium <135 mmol/L at admission.ResultsOverall, 15.6% of patients in the low energy trauma group had hyponatremia. Among patients older than 80 years, women showed distinctly higher rates of hyponatremia (female: 16.4%; male: 5.9%). In contrast only 4.7% of patients who underwent elective hip arthroplasty showed hyponatremia. Patients on sartanes and aldosterone antagonists showed significantly higher rates of hyponatremia. Alcoholism was significantly associated with hyponatremia.ConclusionsWe confirmed a high prevalence of chronic hyponatremia in patients with fractures due to low energy trauma. Our data underscore chronic hyponatremia as a contributing factor to hip fractures. Women older than 80 have a higher risk of developing hyponatremia. Sartanes, aldosterone antagonists, and alcohol disease are associated with hyponatremia. Treating hyponatremia may decrease the risk of fracture after low energy trauma. Therefore, physicians of different specialties should focus on treatment of chronic hyponatremia to reduce the fracture rate associated with low energy trauma.

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“…Previous studies have reported an increase in the risk of fractures associated with hyponatremia, both in participants with CKD 3,4 and in participants without CKD. 5,6 The authors suggest that these findings could be due to gait instability and attention deficits, which increase the risk of falls, or to direct effects of hyponatremia on bone structure.…”

Section: Letter To the Editor In Reply To 'Risks Of Hip And Nonvertebmentioning

confidence: 95%

In Reply to “Risks of Hip and Nonvertebral Fractures in Patients With CKD”

Vilaça

Salam

Eastell

2021

American Journal of Kidney Diseases

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Chronic prolonged hyponatremia and risk of hip fracture in elderly patients with chronic kidney disease

Cited by 14 publications

References 33 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

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

In Reply to “Risks of Hip and Nonvertebral Fractures in Patients With CKD”

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