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Hyponatremia and osteoporosis: insights from the Danish National Patient Registry

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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.

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References

  1. Adrogué HJ, Madias NE (2000) Hyponatremia. N Engl J Med 342(21):1581–1589

    Article  PubMed  Google Scholar 

  2. Holm EA, Brorson SW, Kruse JS, Faber JO, Jespersen B (2004) Hyponatremia in acutely admitted medical patients—occurrence and causes. Ugeskr Laeger 166(45):4033–4037

    PubMed  Google Scholar 

  3. Kleinfeld M, Casimir M, Borra S (1979) Hyponatremia as observed in a chronic disease facility. J Am Geriatr Soc 27(4):156–161

    CAS  PubMed  Google Scholar 

  4. Miller M, Hecker MS, Friedlander DA, Carter JM (1996) Apparent idiopathic hyponatremia in an ambulatory geriatric population. J Am Geriatr Soc 44(4):404–408

    CAS  PubMed  Google Scholar 

  5. Miller M, Morley JE, Rubenstein LZ (1995) Hyponatremia in a nursing home population. J Am Geriatr Soc 43(12):1410–1413

    CAS  PubMed  Google Scholar 

  6. Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, Resnick HE (2010) Hyponatremia-induced osteoporosis. J Bone Miner Res 25(3):554–563

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Sejling AS, Pedersen-bjergaard U, Eiken P (2012) Syndrome of inappropriate ADH secretion and severe osteoporosis. J Clin Endocrinol Metab 97(12):4306–4310

    Article  CAS  PubMed  Google Scholar 

  8. Chow KM, Szeto CC, Kwan BC, Ma TK, Leung CB, Li PK (2012) Fracture risk after thiazide-associated hyponatraemia. Intern Med J 42(7):760–764

    Article  CAS  PubMed  Google Scholar 

  9. Ayus JC, Arieff AI (1999) Chronic hyponatremic encephalopathy in postmenopausal women: association of therapies with morbidity and mortality. JAMA 281(24):2299–2304

    Article  CAS  PubMed  Google Scholar 

  10. 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):1822–1828

    Article  CAS  PubMed  Google Scholar 

  11. 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):368–381

    Article  CAS  PubMed  Google Scholar 

  12. 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.e1–8

    Article  Google Scholar 

  13. 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):733–737

    Article  PubMed  Google Scholar 

  14. 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):385–390

    Article  CAS  PubMed  Google Scholar 

  15. 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–R1435

    Article  CAS  PubMed  Google Scholar 

  16. Sejling AS, Thorsteinsson AL, Pedersen-Bjergaard U, Eiken P (2014) Recovery from SIADH associated osteoporosis - a case report. J Clin Endocrinol Metab: jc20141572

  17. 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):1072–1083

    Article  CAS  PubMed  Google Scholar 

  18. Swart RM, Hoorn EJ, Betjes MG, Zietse R (2011) Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol 118(2):45–51

    Article  PubMed  Google Scholar 

  19. Eisenhut M (2006) Changes in renal sodium transport during a systemic inflammatory response. Pediatr Nephrol 21(10):1487–1488

    Article  PubMed  Google Scholar 

  20. 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):95–100

    Article  CAS  PubMed  Google Scholar 

  21. Rejnmark L, Vestergaard P, Mosekilde L (2005) Reduced fracture risk in users of thiazide diuretics. Calcif Tissue Int 76(3):167–175

    Article  CAS  PubMed  Google Scholar 

  22. 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):1356–1367

    CAS  PubMed  Google Scholar 

  23. Resnick LM, Laragh JH (1985) Calcium metabolism and parathyroid function in primary aldosteronism. Am J Med 78(3):385–390

    Article  CAS  PubMed  Google Scholar 

  24. Aggarwal HK, Jain D, Yadav S, Kaverappa V (2013) Bone mineral density in patients with predialysis chronic kidney disease. Ren Fail 35(8):1105–1111

    Article  CAS  PubMed  Google Scholar 

  25. 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):293–299

    Article  CAS  PubMed  Google Scholar 

  26. 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):457–463

    Article  CAS  PubMed  Google Scholar 

  27. 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):1210–1215

    Article  CAS  PubMed  Google Scholar 

  28. 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):427–430

    Article  Google Scholar 

  29. 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):571–576

    Article  CAS  PubMed  Google Scholar 

  30. Wibaux C, Legroux-Gerot I, Dharancy S et al (2011) Assessing bone status in patients awaiting liver transplantation. Joint Bone Spine 78(4):387–391

    Article  PubMed  Google Scholar 

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Conflicts of interest

CK declares no competing interests. PE is an advisory board member with Amgen, MSD and Eli Lilly and at the speakers bureau with Amgen and Eli Lilly. PV has received unrestricted grants from MSD and Servier and travel grants from Amgen, Eli Lilly, Novartis, Sanofi-Aventis, and Servier.

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Authors and Affiliations

  1. Department of Endocrinology, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark

    C. Kruse & P. Vestergaard

  2. Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hilleroed, Hilleroed, Denmark

    P. Eiken

  3. Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    P. Eiken

  4. Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark

    P. Vestergaard

  5. Clinical Institute, Aalborg University Hospital, Aalborg, Denmark

    P. Vestergaard

Authors
  1. C. Kruse
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  2. P. Eiken
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  3. P. Vestergaard
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Corresponding author

Correspondence to C. Kruse.

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Kruse, C., Eiken, P. & Vestergaard, P. Hyponatremia and osteoporosis: insights from the Danish National Patient Registry. Osteoporos Int 26, 1005–1016 (2015). https://doi.org/10.1007/s00198-014-2973-1

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  • DOI: https://doi.org/10.1007/s00198-014-2973-1

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