Hyponatremia Is Linked to Bone Loss, Osteoporosis, Fragility and Bone Fractures

Barsony, Julianna; Kleess, Lauren; Verbalis, Joseph G.

doi:10.1159/000493237

Cited by 21 publications

(15 citation statements)

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“…18 Mild chronic hyponatremia in older people is associated with cognitive deficits, gait disturbances, and increased rates of falls and fractures. 19 An analysis of the prospective Rotterdam Study, 20…”

Section: Symptoms Of Hyponatremiamentioning

confidence: 99%

“…Mild chronic hyponatremia in older people is associated with cognitive deficits, gait disturbances, and increased rates of falls and fractures . An analysis of the prospective Rotterdam Study, which included 5208 people aged 55 years or older (mean age, 70.3 years) with serum sodium levels at baseline, detected 399 patients with mild hyponatremia (mean serum sodium level, 133.4 mEq/L).…”

Section: Symptoms Of Hyponatremiamentioning

confidence: 99%

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Diagnosis and Management of Hyponatremia

Adrogué

Tucker

Madias

2022

JAMA

116

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Section: Symptoms Of Hyponatremiamentioning

confidence: 99%

Section: Symptoms Of Hyponatremiamentioning

confidence: 99%

Diagnosis and Management of Hyponatremia

Adrogué

Tucker

Madias

2022

JAMA

116

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“…It is indicative of a disturbed water homeostasis that can occur secondary to a broad spectrum of diseases (e.g., heart failure, liver insufficiency, central nervous system disorders) 1 , medications (e.g., diuretics, antiepileptics) 3 , or in stress situation such as in the postoperative period 4 or after extreme sport performances 5 . The awareness by physicians tends to be low 6 although hyponatremia is associated with increased mortality and morbidity 2 such as gait instability 7,8 , falls 7 , osteoporosis 9,10 , fractures 9,10 and attention deficit 7,8,11 . More specifically, hyponatremia is highly relevant in patients with respiratory tract infections because of its high prevalence (8.1%-44.4%) and its prognostic significance [12][13][14][15][16][17] , especially in patients with COVID-19 18 .…”

Section: Introductionmentioning

confidence: 99%

“…diuretics, antiepileptics) ( 2 ), or in stress situation such as in the postoperative period ( 3 ) or after extreme sport performances ( 4 ). The awareness by physicians tends to be low ( 5 ) although hyponatremia is associated with increased mortality and morbidity ( 6 ) such as gait instability ( 7 , 8 ), falls ( 7 ), osteoporosis ( 9 , 10 ), fractures ( 9 , 10 ), and attention deficit ( 7 , 8 , 11 ). More specifically, hyponatremia is highly relevant in patients with respiratory tract infections because of its high prevalence (8.1–44.4%) and its prognostic significance ( 12 , 13 , 14 , 15 , 16 , 17 ), especially in patients with COVID-19 ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study

Atila

Monnerat

Bingisser

et al. 2022

Endocrine Connections

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OBJECTIVE: Hyponatremia in COVID-19 is often due to the syndrome of inadequate antidiuresis (SIAD), possibly mediated by interleukin-6 (IL-6) induced non-osmotic arginine vasopressin (AVP) secretion. We hypothesized an inverse association between IL-6 and plasma sodium concentration, stronger in COVID-19 compared to other respiratory infections. DESIGN: Secondary analysis of a prospective, cohort study including patients with COVID-19 suspicion admitted to the Emergency Department, University Hospital of Basel, Switzerland, between March and July 2020. METHODS: We included patients with PCR-confirmed COVID-19 and patients with similar symptoms, further subclassified in bacterial and other viral respiratory infections. The primary objective was to investigate the association between plasma sodium levels and IL-6 levels. RESULTS: 500 patients were included, 184 (37%) with COVID-19, 92 (18%) with bacterial respiratory infections, 224 (45%) with other viral respiratory infections. In all groups, median [IQR] IL-6 levels were significantly higher in hyponatremic compared to normonatremic patients (COVID-19: 43.4 [28.4, 59.8] vs 9.2 [2.8, 32.7] pg/ml, p<0.0001; bacterial: 122.1 [63.0, 282.0] vs 67.1 [24.9, 252.0] pg/ml, p<0.05; viral: 14.1 [6.9, 84.7] vs 4.3 [2.1, 14.4] pg/ml, p<0.05). IL-6 levels were negatively correlated with plasma sodium levels in COVID-19, whereas the correlation in bacterial and other viral infections was weaker (COVID-19: R= −0.48, p<0.001; bacterial: R= −0.25, p=0.05, viral: R= −0.27, p<0.001). CONCLUSIONS: IL-6 levels were inversely correlated with plasma sodium levels, with a stronger correlation in COVID-19 compared to bacterial and other viral infections. IL-6 might stimulate AVP secretion and lead to higher rates of hyponatremia due to the SIAD in these patients.

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“…In a large cross-sectional study of over 400 women with AN, a lower sodium level (<140mmol/L) was associated with a lower BMD at both the spine and hip compared to those with a sodium level >140mmol/L (reference range: 135-145mmol/L) ( 76 ). Overt hyponatraemia is also a recognised risk factor for bone loss, osteoporosis and fractures ( 77 ). Bone loss in hyponatraemia has been attributed to mobilisation of sodium stores from the bone via increased bone resorption (in an attempt to correct the low sodium), inappropriate vasopressin secretion and a direct effect of hyponatraemia on osteoclast activity ( 78 ).…”

Section: Endocrine Mediators Of Bone Loss In Fhamentioning

confidence: 99%

Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues

Behary

Comninos

2022

Front. Endocrinol.

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One of the most important and potentially long-lasting detrimental consequences of Functional Hypothalamic Amenorrhoea (FHA) is on skeletal homeostasis. Beyond oestrogen deficiency, FHA is associated with a cascade of additional neuro-endocrine and metabolic alterations, some adaptive, but which combine to disrupt skeletal homeostasis. Ultimately, this leads to a two-fold increased risk of fractures in women with FHA compared to healthy eumenorrhoeic women. Although the cornerstone of management of FHA-related bone loss remains recovery of menses via restoration of metabolic/psychological balance, there is rapidly developing evidence for hormonal manipulations (with a particular emphasis on route of administration) and other pharmacological treatments that can protect or improve skeletal homeostasis in FHA. In this mini-review, we provide an update on the pathophysiology, clinical management and future avenues in the field from a bone perspective.

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Hyponatremia Is Linked to Bone Loss, Osteoporosis, Fragility and Bone Fractures

Cited by 21 publications

References 0 publications

Diagnosis and Management of Hyponatremia

Diagnosis and Management of Hyponatremia

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study

Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues

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