Mild prolonged chronic hyponatremia and risk of hip fracture in the elderly

Ayus, Juan Carlos; Fuentes, Nora; Negri, Armando; Moritz, Michael L.; Giunta, Diego; Kalantar-Zadeh, Kamyar; Nigwekar, Sagar U.; Thadhani, Ravi; Go, Alan S.; Quirós, Fernán González Bernaldo de

doi:10.1093/ndt/gfw029

Cited by 67 publications

(78 citation statements)

References 33 publications

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“…This seems consistent with data on previous studies indicating significant changes in BMD via alendronate treatment at the 6 th and 12 th month of therapy (22,23), as well as efficacy of alendronate treatment on prevention of hip fractures in females with or without vertebral fractures starting from the 18 th month of therapy and being maintained for 36 months (24). In fact, although BMD is a strong predictor of fracture, most fractures occur in individuals without osteoporosis by BMD criteria (8). Hence, the likelihood of hyponatremia to lead to fractures through other effects on bone such as decreased bone quality, which is not captured by BMD, has also been emphasized (8).…”

Section: Discussionmentioning

confidence: 99%

“…However, albeit a comparatively little awareness, there is growing evidence that even a mild degree of chronic hyponatremia is associated with multiple clinically significant outcomes in the elderly population (2,8) in regards to immobility and falls (9), bone demineralization and osteoporosis (10), hip fractures (11), cognitive impairment (1) as well as hospital readmission and need for long-term care (12).…”

Section: Introductionmentioning

confidence: 99%

“…Recent data suggest that mild chronic hyponatremia amplifies the fracture risk among elderly not only causing an unsteady gait that leads to falls but also by contributing to bone loss and thereby both to worsening osteoporosis and increased bone fragility directly (4,(8)(9)(10)(11)13).…”

Section: Introductionmentioning

confidence: 99%

“…Given the ongoing debate over the association of hyponatremia with osteoporosis in regards to inconsistent data on bone mineral density (BMD) related changes in hyponatremic patients (8), this retrospective study was designed to evaluate the change in osteoporosis rate and BMD in a cohort hyponatremic versus normonatremic patients under 12-month osteoporosis treatment.…”

Section: Introductionmentioning

confidence: 99%

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Bone Mineral Density and Osteoporosis in Hyponatremic Versus Normonatremic Patients: A Retrospective 12-Month Analysis

Takır¹,

Bakan²,

Tahra³

et al. 2017

Turk Neph Dial Transpl

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OBJECTIVE:To evaluate the change in osteoporosis rate and bone mineral density (BMD) in a cohort hyponatremic versus normonatremic patients under 12-month osteoporosis treatment. MATERIAL and METHODS:A total of 280 patients with osteoporosis who were receiving antiosteoporosis treatment were included in the study. Patients were divided into two groups based on baseline serum sodium levels including hyponatremic (n=45) and normonatremic (n=235) groups. Baseline and follow up data on T scores and rate of osteoporosis were compared in hyponatremic vs. normonatremic groups. RESULTS:Baseline T scores of the femur neck were significantly lower in hyponatremic than in normonatremic (p=0.008) patients, while at the end of 1-year follow up, the two groups had similarly improved T scores of femur neck (p=0.43). Hyponatremic than normonatremic patients had significantly higher rate of osteoporosis (p=0.03) at baseline, whereas two groups had similar osteoporosis rates at the end of 1-year follow up (p=0.25). CONCLUSION:In conclusion, our data suggest a reduced BMD at femur neck and higher rate of osteoporosis in case of mild chronic hyponatremia, whereas similar efficacy of 12-month osteoporosis treatment in improving BMD scores and reducing osteoporosis rate in hyponatremic and normonatremic patients regardless of the natremic status

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bone Mineral Density and Osteoporosis in Hyponatremic Versus Normonatremic Patients: A Retrospective 12-Month Analysis

Takır¹,

Bakan²,

Tahra³

et al. 2017

Turk Neph Dial Transpl

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“…This finding suggests that the skin and the connective tissues may serve as a Na + storage, capable to release Na + in response to reduced intake by changing its polyanionic character [3]. In addition, several studies have recently shown that in both humans and animal models, chronic hyponatremia is associated with bone resorption and osteoporosis [4]. One possibility is that chronic hyponatremia may lead to sodium loss from the bones with consequent bone demineralization [5].…”

Section: Introductionmentioning

confidence: 99%

Plasma Calcium Concentration Modifies the Blood Sodium During Hemodialysis: Lessons from Hard Water Syndrome

Viggiano

Anastasio

2017

BANTAO Journal

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Introduction. Extracellular sodium (Na + ) concentration is maintained within a tight physiological range due to hormonal control, that mainly modulates thirst, Na + and water renal excretion. Extra-renal regulation of Na + and water homeostasis is only partially understood. Recently it has been debated whether the osmotically inactive Na + storage is fixed or variable. Methods. In the present study, fourteen End-Stage Renal Disease (ESRD) patients treated by chronic hemodialysis underwent by accident to a sharp increase in plasmatic calcium (Ca +2 ) levels due to the failure of the water control system, leading to the so-called hard water syndrome. The levels of plasmatic Ca +2 after 1 hr of hemodialysis were correlated with urea, Na + , potassium (K + ) and creatinine levels. Eleven ESRD patients treated with hemodialysis under similar conditions were used as controls. Results. The hard water syndrome resulted in hypercalcemia, while mean plasma levels of Na + , K + and urea were not different compared to controls. Plasma creatinine levels were slightly but significantly higher that control. A correlation analysis on the measured variables has showed a positive correlation between plasma Ca +2 and Na + levels (Pearson=0.428, p=0.032), and the absence of any correlation with K + , creatinine and urea concentration. Conclusions. Our study suggests that acute changes in plasmatic Ca +2 levels may affect Na + concentration in the absence of renal function; it is possible that hypercalcemia may trigger Na + release from the osmotically inactive storage. These data further support previous observations on the interplay of sodium and calcium at extrarenal sites.

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Emergency Management of Acute and Chronic Hyponatremia

Verbalis¹

2018

Endocrine and Metabolic Medical Emergencies

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Mild prolonged chronic hyponatremia and risk of hip fracture in the elderly

Abstract: Mild prolonged chronic hyponatremia is independently associated with hip fracture risk in the elderly population, although the absolute risk is low. However, proof that correcting hyponatremia will result in a reduction of hip fractures is lacking.

Cited by 67 publications

References 33 publications

Bone Mineral Density and Osteoporosis in Hyponatremic Versus Normonatremic Patients: A Retrospective 12-Month Analysis

Bone Mineral Density and Osteoporosis in Hyponatremic Versus Normonatremic Patients: A Retrospective 12-Month Analysis

Plasma Calcium Concentration Modifies the Blood Sodium During Hemodialysis: Lessons from Hard Water Syndrome

Emergency Management of Acute and Chronic Hyponatremia

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