Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy.
Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy.
Calcif Tissue Int. 2020 Jun;106(6):599-607. doi: 10.1007/s00223-020-00675-6. Epub 2020 Feb 19.
Hyponatremia and hypokalemia are common among elderly and have been associated with osteoporosis, we evaluate the role of these electrolytes as risk for fragility fractures.
This study is divided in two parts: one retrospective and one prospective. We retrospectively collected data on urgently admitted patients for femoral fragility fractures (Fx) or for acute myocardial infarction (AMI), and patients admitted for elective hip/knee replacement surgery for osteoarthrosis (OA). Age, sex, serum sodium, potassium, creatinine, and comorbidities were recorded. We enrolled prospectively in-patients from our unit: age, sex, comorbidities, drugs, and fragility fractures were recorded. Blood electrolytes were measured. Cognitive function, nutrition, muscular strength, and balance were evaluated by standard tests. The mortality rate was recorded with a follow-up after hospital discharge.
The retrospective study included 2166 subjects: 702 Fx and 1464 controls (907 AMI, 557 OA): the prevalence of hyponatremia was similar in Fx and AMI, whereas it was higher in Fx with respect to OA (p < 0.001) as well as hypokalemia (p < 0.001). Sodium decrease was associated with higher fracture risk. Among the 284 subjects included in the prospective study, 50 patients were hyponatremic, more likely malnourished, and presented a higher prevalence of fragility fractures (p = 0.008). They had a higher mortality after hospital discharge (HR = 1.80, p = 0.005), however, this association disappears after correction for confounding variables.
We suggest that hyponatremia and hypokalemia have to be considered as a marker of poor health more than an independent fracture risk.
低钠血症和低钾血症在老年人中很常见，并且与骨质疏松症有关，我们评估这些电解质作为脆性骨折风险的作用。
这项研究分为两部分：回顾性和前瞻性。我们回顾性地收集了因股骨脆性骨折（Fx）或急性心肌梗死（AMI）紧急入院的患者以及因骨关节炎（OA）行择期髋关节/膝关节置换手术的患者的数据。记录了年龄、性别、血清钠、钾、肌酐和合并症。我们前瞻性地招募了我们科室的住院患者：记录了年龄、性别、合并症、药物和脆性骨折。测量了血液电解质。通过标准测试评估认知功能、营养、肌肉力量和平衡。记录死亡率，并在出院后进行随访。
回顾性研究纳入了 2166 名患者：702 名 Fx 和 1464 名对照（907 名 AMI，557 名 OA）：低钠血症在 Fx 和 AMI 中的发生率相似，而在 Fx 中高于 AMI（p<0.001）和低钾血症（p<0.001）。钠减少与更高的骨折风险相关。在纳入的 284 名前瞻性研究患者中，50 名患者存在低钠血症，更可能存在营养不良，并且脆性骨折的发生率更高（p=0.008）。他们在出院后死亡率更高（HR=1.80，p=0.005），但在校正混杂变量后这种相关性消失。
我们建议低钠血症和低钾血症应被视为健康状况不佳的标志物，而不仅仅是独立的骨折风险因素。
