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Erschienen in: Osteoporosis International 3/2015

01.03.2015 | Original Article

Hyponatremia and osteoporosis: insights from the Danish National Patient Registry

verfasst von: C. Kruse, P. Eiken, P. Vestergaard

Erschienen in: Osteoporosis International | Ausgabe 3/2015

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Abstract

Summary

The association between hyponatremia and osteoporosis was evaluated in humans. A significant association was found between low sodium levels, lower bone mineralization in the hip, and with several common conditions. Hyponatremia could be used as a marker of osteoporosis and systemic disease.

Introduction

The objective of this study was to evaluate the association between hyponatremia and osteoporosis in humans through a cross-sectional study.

Methods

Patient information was gathered from regional and national Danish patient databases, both in- and outpatient settings, from 2004 to 2011. Patients with dual-energy x-ray absorptiometry (DXA) scans performed within this time were included if accompanied [Na+] was measured within 14 days prior or past the scan date. A total of 1575 patients were included.

Results

A total of 104 patients were hyponatremic (6.6 %). Total hip and lumbar spine bone mineral content (BMC) and densities (BMD) and T-scores were all significantly lower with hyponatremia. The odds ratio (OR) of osteoporosis significantly increased among hyponatremic patients at both total hip (unadjusted OR = 2.17, 95 % CI = [1.40–3.34], p < .05) and lumbar spine (unadjusted OR = 1.83, 95 % CI = [1.20–2.80], p < .05) regions. Dose-response found between increasing [Na+] and increasing total hip BMC (slope .174, adjusted p < .05), BMD (slope .004, adjusted p < .05), and T-score (slope .034, adjusted p < .05). Systemic disease was more prevalent in hyponatremia.

Conclusion

The presence of hyponatremia increases the risk of concurrent osteoporosis at both the total hip and lumbar spine in humans. Hyponatremia could be used a screening tool and marker of secondary osteoporosis.
Literatur
2.
Zurück zum Zitat Holm EA, Brorson SW, Kruse JS, Faber JO, Jespersen B (2004) Hyponatremia in acutely admitted medical patients—occurrence and causes. Ugeskr Laeger 166(45):4033–4037PubMed Holm EA, Brorson SW, Kruse JS, Faber JO, Jespersen B (2004) Hyponatremia in acutely admitted medical patients—occurrence and causes. Ugeskr Laeger 166(45):4033–4037PubMed
3.
Zurück zum Zitat Kleinfeld M, Casimir M, Borra S (1979) Hyponatremia as observed in a chronic disease facility. J Am Geriatr Soc 27(4):156–161PubMed Kleinfeld M, Casimir M, Borra S (1979) Hyponatremia as observed in a chronic disease facility. J Am Geriatr Soc 27(4):156–161PubMed
4.
Zurück zum Zitat Miller M, Hecker MS, Friedlander DA, Carter JM (1996) Apparent idiopathic hyponatremia in an ambulatory geriatric population. J Am Geriatr Soc 44(4):404–408PubMed Miller M, Hecker MS, Friedlander DA, Carter JM (1996) Apparent idiopathic hyponatremia in an ambulatory geriatric population. J Am Geriatr Soc 44(4):404–408PubMed
5.
Zurück zum Zitat Miller M, Morley JE, Rubenstein LZ (1995) Hyponatremia in a nursing home population. J Am Geriatr Soc 43(12):1410–1413PubMed Miller M, Morley JE, Rubenstein LZ (1995) Hyponatremia in a nursing home population. J Am Geriatr Soc 43(12):1410–1413PubMed
6.
Zurück zum Zitat Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, Resnick HE (2010) Hyponatremia-induced osteoporosis. J Bone Miner Res 25(3):554–563CrossRefPubMedCentralPubMed Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, Resnick HE (2010) Hyponatremia-induced osteoporosis. J Bone Miner Res 25(3):554–563CrossRefPubMedCentralPubMed
7.
Zurück zum Zitat Sejling AS, Pedersen-bjergaard U, Eiken P (2012) Syndrome of inappropriate ADH secretion and severe osteoporosis. J Clin Endocrinol Metab 97(12):4306–4310CrossRefPubMed Sejling AS, Pedersen-bjergaard U, Eiken P (2012) Syndrome of inappropriate ADH secretion and severe osteoporosis. J Clin Endocrinol Metab 97(12):4306–4310CrossRefPubMed
8.
Zurück zum Zitat Chow KM, Szeto CC, Kwan BC, Ma TK, Leung CB, Li PK (2012) Fracture risk after thiazide-associated hyponatraemia. Intern Med J 42(7):760–764CrossRefPubMed Chow KM, Szeto CC, Kwan BC, Ma TK, Leung CB, Li PK (2012) Fracture risk after thiazide-associated hyponatraemia. Intern Med J 42(7):760–764CrossRefPubMed
9.
Zurück zum Zitat Ayus JC, Arieff AI (1999) Chronic hyponatremic encephalopathy in postmenopausal women: association of therapies with morbidity and mortality. JAMA 281(24):2299–2304CrossRefPubMed Ayus JC, Arieff AI (1999) Chronic hyponatremic encephalopathy in postmenopausal women: association of therapies with morbidity and mortality. JAMA 281(24):2299–2304CrossRefPubMed
10.
Zurück zum Zitat Hoorn EJ, Rivadeneira F, van Meurs JB et al (2011) Mild hyponatremia as a risk factor for fractures: the Rotterdam study. J Bone Miner Res 26(8):1822–1828CrossRefPubMed Hoorn EJ, Rivadeneira F, van Meurs JB et al (2011) Mild hyponatremia as a risk factor for fractures: the Rotterdam study. J Bone Miner Res 26(8):1822–1828CrossRefPubMed
11.
Zurück zum Zitat Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO study group. Osteoporos Int 4(6):368–381CrossRefPubMed Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO study group. Osteoporos Int 4(6):368–381CrossRefPubMed
12.
Zurück zum Zitat Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119(1):71.e1–8CrossRef Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119(1):71.e1–8CrossRef
13.
Zurück zum Zitat Sandhu HS, Gilles E, Devita MV, Panagopoulos G, Michelis MF (2009) Hyponatremia associated with large-bone fracture in elderly patients. Int Urol Nephrol 41(3):733–737CrossRefPubMed Sandhu HS, Gilles E, Devita MV, Panagopoulos G, Michelis MF (2009) Hyponatremia associated with large-bone fracture in elderly patients. Int Urol Nephrol 41(3):733–737CrossRefPubMed
14.
Zurück zum Zitat Abrahamsen B, Gram J, Hansen TB, Beck-Nielsen H (1995) Cross calibration of QDR-2000 and QDR-1000 dual-energy X-ray densitometers for bone mineral and soft-tissue measurements. Bone 16(3):385–390CrossRefPubMed Abrahamsen B, Gram J, Hansen TB, Beck-Nielsen H (1995) Cross calibration of QDR-2000 and QDR-1000 dual-energy X-ray densitometers for bone mineral and soft-tissue measurements. Bone 16(3):385–390CrossRefPubMed
15.
Zurück zum Zitat Seeliger E, Ladwig M, Reinhardt HW (2006) Are large amounts of sodium stored in an osmotically inactive form during sodium retention? Balance studies in freely moving dogs. Am J Physiol Regul Integr Comp Physiol 290(5):R1429–R1435CrossRefPubMed Seeliger E, Ladwig M, Reinhardt HW (2006) Are large amounts of sodium stored in an osmotically inactive form during sodium retention? Balance studies in freely moving dogs. Am J Physiol Regul Integr Comp Physiol 290(5):R1429–R1435CrossRefPubMed
16.
Zurück zum Zitat Sejling AS, Thorsteinsson AL, Pedersen-Bjergaard U, Eiken P (2014) Recovery from SIADH associated osteoporosis - a case report. J Clin Endocrinol Metab: jc20141572 Sejling AS, Thorsteinsson AL, Pedersen-Bjergaard U, Eiken P (2014) Recovery from SIADH associated osteoporosis - a case report. J Clin Endocrinol Metab: jc20141572
17.
Zurück zum Zitat Schmidt C, Höcherl K, Schweda F, Kurtz A, Bucher M (2007) Regulation of renal sodium transporters during severe inflammation. J Am Soc Nephrol 18(4):1072–1083CrossRefPubMed Schmidt C, Höcherl K, Schweda F, Kurtz A, Bucher M (2007) Regulation of renal sodium transporters during severe inflammation. J Am Soc Nephrol 18(4):1072–1083CrossRefPubMed
18.
Zurück zum Zitat Swart RM, Hoorn EJ, Betjes MG, Zietse R (2011) Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol 118(2):45–51CrossRefPubMed Swart RM, Hoorn EJ, Betjes MG, Zietse R (2011) Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol 118(2):45–51CrossRefPubMed
19.
Zurück zum Zitat Eisenhut M (2006) Changes in renal sodium transport during a systemic inflammatory response. Pediatr Nephrol 21(10):1487–1488CrossRefPubMed Eisenhut M (2006) Changes in renal sodium transport during a systemic inflammatory response. Pediatr Nephrol 21(10):1487–1488CrossRefPubMed
20.
Zurück zum Zitat Arakelyan KP, Sahakyan YA, Hayrapetyan LR, Khudaverdyan DN, Ingelman-Sundberg M, Mkrtchian S, Ter-Markosyan AS (2007) Calcium-regulating peptide hormones and blood electrolytic balance in chronic heart failure. Regul Pept 142(3):95–100CrossRefPubMed Arakelyan KP, Sahakyan YA, Hayrapetyan LR, Khudaverdyan DN, Ingelman-Sundberg M, Mkrtchian S, Ter-Markosyan AS (2007) Calcium-regulating peptide hormones and blood electrolytic balance in chronic heart failure. Regul Pept 142(3):95–100CrossRefPubMed
21.
Zurück zum Zitat Rejnmark L, Vestergaard P, Mosekilde L (2005) Reduced fracture risk in users of thiazide diuretics. Calcif Tissue Int 76(3):167–175CrossRefPubMed Rejnmark L, Vestergaard P, Mosekilde L (2005) Reduced fracture risk in users of thiazide diuretics. Calcif Tissue Int 76(3):167–175CrossRefPubMed
22.
Zurück zum Zitat Jespersen B, Randløv A, Abrahamsen J, Fogh-Andersen N, Kanstrup IL (1997) Effects of PTH(1–34) on blood pressure, renal function, and hormones in essential hypertension: the altered pattern of reactivity may counteract raised blood pressure. Am J Hypertens 10(12 Pt 1):1356–1367PubMed Jespersen B, Randløv A, Abrahamsen J, Fogh-Andersen N, Kanstrup IL (1997) Effects of PTH(1–34) on blood pressure, renal function, and hormones in essential hypertension: the altered pattern of reactivity may counteract raised blood pressure. Am J Hypertens 10(12 Pt 1):1356–1367PubMed
23.
Zurück zum Zitat Resnick LM, Laragh JH (1985) Calcium metabolism and parathyroid function in primary aldosteronism. Am J Med 78(3):385–390CrossRefPubMed Resnick LM, Laragh JH (1985) Calcium metabolism and parathyroid function in primary aldosteronism. Am J Med 78(3):385–390CrossRefPubMed
24.
Zurück zum Zitat Aggarwal HK, Jain D, Yadav S, Kaverappa V (2013) Bone mineral density in patients with predialysis chronic kidney disease. Ren Fail 35(8):1105–1111CrossRefPubMed Aggarwal HK, Jain D, Yadav S, Kaverappa V (2013) Bone mineral density in patients with predialysis chronic kidney disease. Ren Fail 35(8):1105–1111CrossRefPubMed
25.
Zurück zum Zitat Amerling R, Harbord NB, Pullman J, Feinfeld DA (2010) Bisphosphonate use in chronic kidney disease: association with adynamic bone disease in a bone histology series. Blood Purif 29(3):293–299CrossRefPubMed Amerling R, Harbord NB, Pullman J, Feinfeld DA (2010) Bisphosphonate use in chronic kidney disease: association with adynamic bone disease in a bone histology series. Blood Purif 29(3):293–299CrossRefPubMed
26.
Zurück zum Zitat Heaf J, Tvedegaard E, Kanstrup IL, Fogh-Andersen N (2000) Bone loss after renal transplantation: role of hyperparathyroidism, acidosis, cyclosporine and systemic disease. Clin Transplant 14(5):457–463CrossRefPubMed Heaf J, Tvedegaard E, Kanstrup IL, Fogh-Andersen N (2000) Bone loss after renal transplantation: role of hyperparathyroidism, acidosis, cyclosporine and systemic disease. Clin Transplant 14(5):457–463CrossRefPubMed
27.
Zurück zum Zitat Abdelhadi M, Eriksson SA, Ljusk Eriksson S, Ericzon BG, Nordenström J (1995) Bone mineral status in end-stage liver disease and the effect of liver transplantation. Scand J Gastroenterol 30(12):1210–1215CrossRefPubMed Abdelhadi M, Eriksson SA, Ljusk Eriksson S, Ericzon BG, Nordenström J (1995) Bone mineral status in end-stage liver disease and the effect of liver transplantation. Scand J Gastroenterol 30(12):1210–1215CrossRefPubMed
28.
Zurück zum Zitat Díez-Ruiz A, García-Saura PL, García-Ruiz P, González-Calvin JL, Gallego-Rojo F, Fuchs D (2010) Bone mineral density, bone turnover markers and cytokines in alcohol-induced cirrhosis. Alcohol 45(5):427–430CrossRef Díez-Ruiz A, García-Saura PL, García-Ruiz P, González-Calvin JL, Gallego-Rojo F, Fuchs D (2010) Bone mineral density, bone turnover markers and cytokines in alcohol-induced cirrhosis. Alcohol 45(5):427–430CrossRef
29.
Zurück zum Zitat Monegal A, Navasa M, Peris P et al (2013) Bone disease in patients awaiting liver transplantation. Has the situation improved in the last two decades? Calcif Tissue Int 93(6):571–576CrossRefPubMed Monegal A, Navasa M, Peris P et al (2013) Bone disease in patients awaiting liver transplantation. Has the situation improved in the last two decades? Calcif Tissue Int 93(6):571–576CrossRefPubMed
30.
Zurück zum Zitat Wibaux C, Legroux-Gerot I, Dharancy S et al (2011) Assessing bone status in patients awaiting liver transplantation. Joint Bone Spine 78(4):387–391CrossRefPubMed Wibaux C, Legroux-Gerot I, Dharancy S et al (2011) Assessing bone status in patients awaiting liver transplantation. Joint Bone Spine 78(4):387–391CrossRefPubMed
Metadaten
Titel
Hyponatremia and osteoporosis: insights from the Danish National Patient Registry
verfasst von
C. Kruse
P. Eiken
P. Vestergaard
Publikationsdatum
01.03.2015
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 3/2015
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-014-2973-1

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