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Hyponatremia may be risk factor for fractures in elderly
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13th European Congress of Endocrinology
Mild hyponatremia in the elderly is associated with an increased risk for fractures, leading researchers to suggest that elderly patients with fractures may benefit from screening for hyponatremia.
Hyponatremia occurs most often in elderly and hospitalized patients, and recent studies have suggested a correlation with fractures in this population. However, this association had not been demonstrated in prospective studies. Carola Zillikens, MD, and colleagues at Erasmus MC in the Netherlands collected data from the population-based Rotterdam study to determine whether hyponatremia is linked to fractures, falls and bone mineral density in older patients. The researchers assessed sodium levels in blood samples from 5,208 elderly men and women, and analyzed data on BMD, recent falls, comorbidity, medication, mortality, vertebral fractures (mean follow-up, 6.4 years) and non-vertebral fractures (mean follow-up, 7.4 years).
About 8% of patients had hyponatremia (n=399). Those with hyponatremia were more likely to be older (73.5 years vs. 70 years); had more recent falls (23.8% vs. 16.4%), but no effect on fracture; had a higher prevalence of type 2 diabetes (22.2% vs. 10.3%); and used diuretics more often (31.1% vs. 15%) than patients without hyponatremia.
Patients with hyponatremia were 40% more likely to experience an incident non-vertebral fracture during follow-up (HR=1.39; 95% CI, 1.11-1.73) or a vertebral fracture at first presentation (OR=1.78; 95% CI, 1.04-3.06) but not at follow-up, compared with those who did not have hyponatremia. There was no association between hyponatremia and BMD, as is the case in osteoporosis, according to the researchers.
Additionally, the presence of hyponatremia was associated with a higher risk for all-cause mortality (HR=1.21; 95% CI, 1.03-1.43).
From this, it is unclear whether hyponatremia is a causal factor in the development of fractures or whether it is just an indicator that a patient may be at risk. Fracture risk in patients with hyponatremia was independent of recent falls, indicating that hyponatremia may be affecting some other aspect of bone quality, the researchers said.
“Our next step is to see if these findings can be replicated in independent populations,” Zillikens said in a press release. “If we can do this, it may be advisable to implement a screening program for hyponatremia in elderly patients that present with fractures. Physicians may consider treatment of mild hyponatremia if future studies show that treatment of mild hyponatremia decreases fracture risk.”
For more information:
- Hoorn EJ. Abstract 26 OC3.1. Presented at: 13th European Congress of Endocrinology; Apr. 30-May 4, 2011; Rotterdam, the Netherlands.
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