Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
J Bone Miner Res. 2011 Aug;26(8):1822-8. doi: 10.1002/jbmr.380.
Recent studies suggest that mild hyponatremia is associated with fractures, but prospective studies are lacking. We studied whether hyponatremia is associated with fractures, falls, and/or bone mineral density (BMD). A total of 5208 elderly subjects with serum sodium assessed at baseline were included from the prospective population-based Rotterdam Study. The following data were analyzed: BMD, vertebral fractures (mean follow-up 6.4 years), nonvertebral fractures (7.4 years), recent falls, comorbidity, medication, and mortality. Hyponatremia was detected in 399 subjects (7.7%, 133.4 ± 2.0 mmol/L). Subjects with hyponatremia were older (73.5 ± 10.3 years versus 70.0 ± 9.0 years, p < .001), had more recent falls (23.8% versus 16.4%, p < .01), higher type 2 diabetes mellitus prevalence (22.2% versus 10.3%, p < .001), and more often used diuretics (31.1% versus 15.0%, p < .001). Hyponatremia was not associated with lower BMD but was associated with increased risk of incident nonvertebral fractures [hazard ratio (HR) =1.39, 95% confidence interval (CI) 1.11-1.73, p = .004] after adjustment for age, sex, and body mass index. Further adjustments for disability index, use of diuretics, use of psycholeptics, recent falls, and diabetes did not modify results. In the fully adjusted model, subjects with hyponatremia also had increased risk of vertebral fractures at baseline [odds ratio (OR) = 1.78, 95% CI 1.04-3.06, p = .037] but not at follow-up. Finally, all-cause mortality was higher in subjects with hyponatremia (HR = 1.21, 95% CI 1.03-1.43, p = .022). It is concluded that mild hyponatremia in the elderly is associated with an increased risk of vertebral fractures and incident nonvertebral fractures but not with BMD. Increased fracture risk in hyponatremia also was independent of recent falls, pointing toward a possible effect on bone quality.
最近的研究表明，轻度低钠血症与骨折有关，但缺乏前瞻性研究。我们研究了低钠血症是否与骨折、跌倒和/或骨密度（BMD）有关。共纳入了来自前瞻性人群基础的鹿特丹研究中的 5208 名血清钠评估基线的老年受试者。分析了以下数据：BMD、椎体骨折（平均随访 6.4 年）、非椎体骨折（7.4 年）、近期跌倒、合并症、药物治疗和死亡率。399 名受试者（7.7%，133.4 ± 2.0 mmol/L）检测到低钠血症。低钠血症患者年龄较大（73.5 ± 10.3 岁比 70.0 ± 9.0 岁，p < 0.001），近期跌倒发生率较高（23.8%比 16.4%，p < 0.01），2 型糖尿病患病率较高（22.2%比 10.3%，p < 0.001），利尿剂使用率更高（31.1%比 15.0%，p < 0.001）。低钠血症与 BMD 降低无关，但与非椎体骨折的发生风险增加相关[风险比（HR）=1.39，95%置信区间（CI）1.11-1.73，p = 0.004]，调整年龄、性别和体重指数后。进一步调整残疾指数、利尿剂使用、精神药物使用、近期跌倒和糖尿病并未改变结果。在完全调整的模型中，低钠血症受试者在基线时也有更高的椎体骨折风险[优势比（OR）=1.78，95%CI 1.04-3.06，p = 0.037]，但在随访时没有。最后，低钠血症患者的全因死亡率较高（HR = 1.21，95%CI 1.03-1.43，p = 0.022）。结论是，老年人轻度低钠血症与椎体骨折和非椎体骨折的发生风险增加有关，但与 BMD 无关。低钠血症时骨折风险增加也与近期跌倒无关，提示可能对骨质量有影响。
