Hyponatremia, a risk factor for osteoporosis and fractures in women

Holm, Jakob; Amar, Anas Ould Si; Hyldstrup, Lars; Jensen, Jens–Erik Beck

doi:10.1007/s00198-015-3370-0

Cited by 26 publications

(21 citation statements)

References 37 publications

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“…Preoperative optimization is an important aspect of successful postoperative recovery in adult patients undergoing spinal surgery. 1,2 In addition to baseline patient comorbidities, [3][4][5] there is increasing evidence that abnormal preoperative lab values such as hemoglobin (Hb), hematocrit (Hct), Hemoglobin A1c (HbA1c), and electrolyte abnormalities are risk factors for poor post-operative outcomes. 4,6 Hb is a polymeric protein found in red blood cells (RBCs) and is the primary mechanism of oxygen delivery to tissues.…”

Section: Introductionmentioning

confidence: 99%

Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

Suresh

Wang

Sethi

et al. 2021

Global Spine Journal

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Study Design: Systematic review. Objectives: Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD). Methods: We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries. Results: Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria. PCF and ACDF: Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay. PLF: Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores. LD: LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation. Conclusion: In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification. Level of Evidence: III

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Section: Introductionmentioning

confidence: 99%

Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

Suresh

Wang

Sethi

et al. 2021

Global Spine Journal

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“…Since most of the studies to date have mainly focused on postmenopausal osteoporosis, though some studies have revealed the risk factors for variation in bone status in premenopausal women [ 8 , 9 , 10 ], the differences in risk factors for premenopausal and postmenopausal osteoporosis have not yet been clearly evaluated. In addition, despite the large number of studies attempting to identify various risk factors for bone loss, only a few have analyzed the correlation between urine and/or serum electrolytes, biochemical measurements, and the risk of osteoporosis [ 11 , 12 , 13 ]. The current study aims to identify the premenopausal and postmenopausal risk factors of bone loss in urine and serum electrolytes and biochemical values using longitudinal and cross-sectional cohorts.…”

Section: Introductionmentioning

confidence: 99%

Urine and Serum Electrolytes and Biochemical Values Associated with Osteoporosis in Premenopausal and Postmenopausal Women: A Longitudinal and Cross-Sectional Study Using Korean Genome and Epidemiology Study (KoGES) Cohort

Park

Kim

et al. 2021

JCM

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Osteoporosis is a major public health concern, especially in women. This study aims to identify early biomarkers from biochemical measurements of serum and urine for recognizing the development of osteoporosis and osteopenia in premenopausal and postmenopausal women. From the Korean Genome and Epidemiology Study (KoGES) cohort, longitudinal study participants with normal bone density were enrolled and assessed for the association of baseline clinical and biochemical factors with osteoporosis development over 4 years. In addition, a cross-sectional study between normal bone density and osteopenia/osteoporosis was conducted to validate the risk factors found in the longitudinal cohort. Of the 5272 female participants in the KoGES cohort, 813 women (501 premenopausal and 312 menopausal) who had normal bone density at baseline were included in the longitudinal study. During the 4 years of follow-up, 64 patients developed osteoporosis and 354 developed osteopenia. In a multivariate logistic regression analysis, serum calcium and urine uric acid levels were significantly associated with elevated osteoporosis risk in premenopausal and postmenopausal women, respectively (risk of osteoporosis by serum calcium levels in premenopausal women: 4.03 (1.09–14.93), p = 0.037; risk of osteoporosis by urine uric acid levels in postmenopausal women: 24.08 (1.79–323.69), p = 0.016). For the cross-sectional study, serum and urine parameters were compared between women with osteopenia or osteoporosis at baseline and those with normal bone density. Urine uric acid levels were found to be significantly higher in both premenopausal and postmenopausal women with bone loss than in women with normal bone density (p < 0.001 and p = 0.004, respectively). Uric acid level in urine may be an early marker for the development of osteoporosis in women, especially after menopause.

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“…In a cohort study on 5,610 patients, hyponatremia was associated with a significant lower T-score at total hip in the multivariate analysis, and a borderline significant lower T-score at femoral neck; however, there was no association between hyponatremia and lumbar spine T-score. In the same series, hyponatremia was associated with an increased HR for major osteoporotic fractures in women, ranging from 6 months before and 12 months after sodium measurement [30].…”

Section: Resultsmentioning

confidence: 77%

Mild Chronic Hyponatremia and Osteoporotic Fractures Risk in Elderly

Trifănescu¹,

Soare²,

Carstoiu³

et al. 2019

Rev. Chim.

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Low serum sodium levels were associated with increased prevalence of osteoporosis and fractures. The aim of the study was to assess the relationship between serum sodium and bone mineral density and/or osteoporotic fractures� prevalence in elderly people. A total number of 260 patients (23 men / 237 women), aged 66.5 � 12.8 years, were retrospectively assessed. Serum sodium levels were measured in all patients. Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA). Results: serum natremia was 140.3 � 4.4 mmol/L; prevalence of hyponatremia was 7.3%; frailty fractures were present in 117 out of 260 patients (45%). Patients with fractures had lower serum sodium levels as compared to patients without fractures (139 � 3.9 vs. 141.5 � 4.6 mmol/L, p [ 0.001). Patients with osteoporosis (n = 179) also showed lower natremia as compared to patients with normal BMD and osteopenia (n = 81): 139.9 � 4.7 vs. 141.2 � 3.8 mmol/L, p = 0.035. In patients admitted in the hospital for fractures (n = 92), prevalence of hyponatremia was 13.04%. Hyponatremic patients had significantly higher prevalence of fractures (73.7% vs. 42.7%, p = 0.0147) as compared to normonatremic patients. Odds ratio (OR) for fractures in patients with hyponatremia was 3.75 [95% C.I.: 1.3-10.75], p = 0.0138; OR for hip fractures in patients with hyponatremia was 3.65 [95% C.I.: 1.38-9.64], p = 0.0089. Both incidence and prevalence of hyponatremia increase with age, especially in patients treated with diuretics. Several clinical studies found an association between mild chronic hyponatremia in elderly and increased odds ratio of osteoporosis at the total and at femoral neck; the study also showed an increased odds ratio for all fractures and for hip fractures in hyponatremic patients. Elderly people at risk of osteoporotic fractures should have sodium serum measured.

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Hyponatremia, a risk factor for osteoporosis and fractures in women

Abstract: Our data suggest that hyponatremia in women increases the risk of osteoporosis and MOF. The increased risk of MOF was independent of osteoporosis.

Cited by 26 publications

References 37 publications

Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

Urine and Serum Electrolytes and Biochemical Values Associated with Osteoporosis in Premenopausal and Postmenopausal Women: A Longitudinal and Cross-Sectional Study Using Korean Genome and Epidemiology Study (KoGES) Cohort

Mild Chronic Hyponatremia and Osteoporotic Fractures Risk in Elderly

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