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Hyponatremia and osteoporosis: reappraisal of a novel association

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Abstract

Summary

Age was a modifier of the independent association between hyponatremia and osteoporosis (OP). Risk of OP was the highest in the youngest age group as compared to older patients. A longer duration of hyponatremia revealed a similar association with OP in all anatomical sites.

Introduction

Epidemiologic studies provide conflicting results on the relationship between hyponatremia and OP. Our aim is to test the modification effect of age on the relationship between hyponatremia and OP at various anatomical sites in a large patient population.

Methods

This is a cross-sectional observation of consecutive patients with available bone densitometry, demographic, clinical, and laboratory data from 2001 to 2013 at a single center. OP was defined as a bone mineral density of ≤2.5 standard deviations below the mean peak bone mass of young, healthy adults. Hyponatremia was defined as serum sodium ≤135 mmol/L. Multiple logistic regressions were used to calculate adjusted odds ratio (OR).

Results

Overall, 24,784 patients were included. There were 4549 males (18.4 %). Hyponatremia was present in 703 patients (2.8 %), femoral neck OP in 2603 (10.5 %), total hip OP in 1885 (7.5 %), and lumbar OP in 4830 (19.5 %). Total hip OP occurred in 17.6 % (n = 124) of patients with hyponatremia as compared to 6.6 % (n = 880) of patients with sodium level of “140–145” mmol/L (P < 0.001). After multivariable adjustments, hyponatremia was associated with 2.46-fold higher odds of total hip OP (95 % CI, 1.36 to 4.46) in age <55 years, 1.96-fold (1.13 to 3.41) in age 55 to 67 years, and 1.55-fold (1.13 to 2.12) in age >67 years (age-sodium category interaction P value = 0.002).

Conclusions

Age appeared as a modifier of the independent association between hyponatremia and OP. Risk of OP was the highest in the youngest age group as compared to older patients.

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Acknowledgments

F.A. received support from 5T32DK7378-34 NIH grant. The authors thank Lalitha Natarajan at the Medical Center Information Technology of the University of Michigan for data transfer.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr., SPC 5364, Ann Arbor, MI, 48109, USA

    F. Afshinnia

  2. Division of Radiology, Thomas Jefferson University, Philadelphia, PA, USA

    B. Sundaram

  3. Department of Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA

    R. J. Ackermann & K. K. Wong

  4. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    K. K. Wong

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  1. F. Afshinnia
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  2. B. Sundaram
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Corresponding author

Correspondence to F. Afshinnia.

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Afshinnia, F., Sundaram, B., Ackermann, R.J. et al. Hyponatremia and osteoporosis: reappraisal of a novel association. Osteoporos Int 26, 2291–2298 (2015). https://doi.org/10.1007/s00198-015-3108-z

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  • DOI: https://doi.org/10.1007/s00198-015-3108-z

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