Endocr Pract. 2019 Apr;25(4):366-378. doi: 10.4158/EP-2018-0499. Epub 2019 Jan 18.
Hyponatremia decreases bone mineral density and is a major risk factor for fragility fractures. Objectives of our systematic review and meta-analysis were to analyze the overall effects of hyponatremia on bone fractures, osteoporosis, and mortality. We extracted data from Medline, Cochrane Central, and EMBASE 1960-2017 and conference abstracts from 2007-2017. We included studies with data on serum sodium, fractures, bone density, or diagnoses of osteoporosis. Studies were independently reviewed by two authors and assessed for bias using the Newcastle-Ottawa scale. Random effect models meta-analysis was used when at least three studies reported the same outcome measures. We reported summary odds ratios (ORs) and 95% confidence intervals (CIs). We included 26 studies for qualitative analysis. Fifteen studies were included in the meta-analysis to evaluate the effects of hyponatremia on fractures, four studies for bone mineral density changes, and six for mortality. Hyponatremia increased the odds of fractures at all sites (summary OR, 2.34 [95% CI, 1.86, 2.96]. There was an increase in the odds of osteoporosis (summary OR, 2.67 [95% CI, 2.07, 3.43]). Mortality risk among the included studies remained high (summary OR, 1.31 [95% CI, 1.16, 1.47]). Our meta-analysis confirms a statistically significant association of hyponatremia with bone fractures and osteoporosis along with higher mortality. Long-term prospective studies evaluating the impact of correcting hyponatremia on bone health, fractures, and mortality are required. = arginine vasopressin; = confidence interval; = chronic kidney disease; = odds ratio; = syndrome of inappropriate antidiuretic hormone.
低钠血症会降低骨密度，是脆性骨折的主要危险因素。本系统评价和荟萃分析的目的是分析低钠血症对骨折、骨质疏松症和死亡率的总体影响。我们从 Medline、Cochrane 中心和 EMBASE（1960-2017 年）以及 2007-2017 年的会议摘要中提取数据。我们纳入了有血清钠、骨折、骨密度或骨质疏松症诊断数据的研究。研究由两位作者独立审查，并使用纽卡斯尔-渥太华量表评估偏倚。当至少有三项研究报告相同的结果测量时，我们使用随机效应模型荟萃分析。我们报告了汇总优势比（OR）和 95%置信区间（CI）。我们进行了定性分析，共纳入 26 项研究。15 项研究纳入荟萃分析评估低钠血症对骨折的影响，4 项研究评估骨密度变化，6 项研究评估死亡率。低钠血症使所有部位骨折的几率增加（汇总 OR，2.34 [95% CI，1.86，2.96]）。骨质疏松症的几率增加（汇总 OR，2.67 [95% CI，2.07，3.43]）。纳入研究的死亡率仍然很高（汇总 OR，1.31 [95% CI，1.16，1.47]）。我们的荟萃分析证实，低钠血症与骨折和骨质疏松症以及更高的死亡率之间存在统计学上显著的关联。需要进行长期前瞻性研究，评估纠正低钠血症对骨骼健康、骨折和死亡率的影响。
