Hyponatremia independent of osteoporosis is associated with fracture occurrence

Abstract

Background and objectives: Mild hyponatremia has traditionally been considered benign, but it may be associated with gait and attention deficits and an increased risk of falls that may result in fracture. A retrospective study was conducted to quantify the association of hyponatremia with fracture occurrence and to examine whether this relationship is independent of osteoporosis.

Design, setting, participants, & measurements: This study analyzed 1408 consecutive female patients who underwent bone mineral density measurement (Lunar IDXA) between September 1, 2006 and April 11, 2007 and who had available laboratory data. Self reported fracture occurrence was confirmed by radiology report or attendance at a fracture clinic. The significance and independence of the association of hyponatremia with fracture was quantified using logistic regression.

Results: The mean (SD) serum sodium ([Na(+)]) was 140.6 (3.0) mmol/L; 59 (4.2%) had [Na(+)] < 135 mmol/L. Forty-five percent of subjects were osteoporotic and 18% had a prior fracture. Hyponatremia was present in 8.7% of those with versus 3.2% of those without a confirmed fracture (P < 0.001). On multivariate logistic regression analysis controlling for age, T-score, chronic kidney disease stage, osteoporotic risk factors (amenorrhea, family history, regular steroid use, smoking history, alcohol use, history of liver disease, and low-calcium diet), and osteoporosis treatments (calcium and vitamin D supplements, antiresorptives, and hormonal replacement therapy), [Na(+)] < 135 versus [Na(+)] >or= 135 mmol/L remained significantly and independently associated with fracture occurrence (P < 0.01).

Conclusions: Mild hyponatremia may be a readily identifiable and potentially modifiable risk factor for fracture.

Figure 1.

Distribution of [Na⁺] values in 1408 women undergoing DXA scanning.

Figure 2.

OR (95% CI) of fracture occurrence by [Na⁺] category, adjusting simultaneously for age (years), T-score, CKD stage, osteoporotic risk factors (amenorrhea, low dietary calcium intake, high alcohol intake, maintenance steroids, ever having smoked, family history of osteoporosis, and history of liver disease), and osteoporosis therapy (use of calcium, vitamin D, antiresorptive therapy, hormonal replacement therapy).