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Observational Study
. 2021 Apr;94(4):616-624.
doi: 10.1111/cen.14367. Epub 2020 Dec 26.

The effects of acute hyponatraemia on bone turnover in patients with subarachnoid haemorrhage: A preliminary report

Aoife Garrahy  1 , Iona Galloway  1 , Anne Marie Hannon  1 , Rosemary Dineen  1 , Mohsen Javadpour  2 , William P Tormey  3 , K J Gan  4 , Patrick J Twomey  5 , Malachi J Mc Kenna  4 , Mark Kilbane  5 , Rachel K Crowley  4 , Mark Sherlock  1 , Christopher J Thompson  1
Affiliations
Observational Study

The effects of acute hyponatraemia on bone turnover in patients with subarachnoid haemorrhage: A preliminary report

Aoife Garrahy et al. Clin Endocrinol (Oxf). 2021 Apr.

Abstract

Context: Animal data and cross-sectional human studies have established that chronic hyponatraemia predisposes to osteoporosis; the effects of acute hyponatraemia on bone turnover have not been determined. Our objective was to test the hypothesis that acute hyponatraemia leads to dynamic effects on bone turnover.

Design: A prospective observational pilot study.

Methods: Bone turnover markers [C-terminal crosslinking telopeptide of type 1 collagen (CTX-1), N-propeptide of type 1 collagen (P1NP) and osteocalcin] were measured prospectively over one week in 22 eunatraemic patients with subarachnoid haemorrhage. Patients treated with glucocorticoids were excluded.

Results: Eight patients developed acute hyponatraemia, median nadir plasma sodium concentration 131 mmol/L (IQR 128-132), and 14 remained eunatraemic, nadir plasma sodium concentration 136 mmol/L (IQR 133-137). Significant main effects of hyponatraemia were found for P1NP (p = .02) and P1NP:CTX-1 ratio (p = .02), both fell in patients with acute hyponatraemia, with significant interaction between hyponatraemia and time from baseline for P1NP (p = .02). Significant main effects of time from baseline (p < .001) but not hyponatraemia (p = .07) were found for osteocalcin. For CTX-1, significant main effects of time from baseline (p = .001) but not hyponatraemia (p = .65) were found. There was a positive correlation between change in P1NP:CTX-1 ratio and nadir plasma sodium concentration, r = +.43, p = .04. Median serum cortisol (measured on days 1, 3 and 7) was higher in the hyponatraemia group than in those who remained eunatraemic, 545 nmol/L (IQR 373-778) versus 444 nmol/L (IQR 379-542) p = .03.

Conclusion: These data suggest that acute mild hyponatraemia is associated with a reduction in bone formation activity.

Keywords: bone; hyponatraemia; osteoporosis.

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References

REFERENCES

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