Jäckle Katharina, Klockner Friederike, Hoffmann Daniel Bernd, Roch Paul Jonathan, Reinhold Maximilian, Lehmann Wolfgang, Weiser Lukas
Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany.
Medicina (Kaunas). 2021 Nov 10;57(11):1224. doi: 10.3390/medicina57111224.
Hyponatremia is the most common electrolyte disorder in elderly and associated with increased risk of falls. Clinical studies as well as small animal experiments suggested an association between chronic hyponatremia and osteoporosis. Furthermore, it has been assumed that subtle hyponatremia may be an independent fracture risk in the elderly. Therefore, this study was designed to evaluate the possible influence of chronic hyponatremia on osteoporosis and low-energy fractures of the spine. 144 patients with a vertebral body fracture (mean age: 69.15 ± 16.08; 73 females and 71 males) due to low-energy trauma were treated in a level one trauma center within one year and were included in the study. Chronic hyponatremia was defined as serum sodium < 135 mmol/L at admission. Bone mineral density (BMD) of the spine was measured using quantitative computed tomography in each patient. Overall, 19.44% (n = 28) of patients in the low-energy trauma group had hyponatremia. In the group with fractures caused by low-energy trauma, the proportion of hyponatremia of patients older than 65 years was significantly increased as compared to younger patients (* = 0.0016). Furthermore, there was no significant gender difference in the hyponatremia group. Of 28 patients with chronic hyponatremia, all patients had decreased bone quality. Four patients showed osteopenia and the other 24 patients even showed osteoporosis. In the low-energy trauma group, the BMD correlated significantly with serum sodium (r = 0.396; ** < 0.001). The results suggest that chronic hyponatremia affects bone quality. Patients with chronic hyponatremia have an increased prevalence of fractures after low-energy trauma due to a decreased bone quality. Therefore, physicians from different specialties should focus on the treatment of chronic hyponatremia to reduce the fracture rate after low-energy trauma, particularly with elderly patients.
低钠血症是老年人中最常见的电解质紊乱，且与跌倒风险增加相关。临床研究以及小动物实验表明慢性低钠血症与骨质疏松症之间存在关联。此外，人们认为轻度低钠血症可能是老年人独立的骨折风险因素。因此，本研究旨在评估慢性低钠血症对骨质疏松症和脊柱低能量骨折的可能影响。144例因低能量创伤导致椎体骨折的患者（平均年龄：69.15±16.08；女性73例，男性71例）在一家一级创伤中心接受了为期一年的治疗，并被纳入研究。慢性低钠血症定义为入院时血清钠<135 mmol/L。使用定量计算机断层扫描测量每位患者的脊柱骨密度（BMD）。总体而言，低能量创伤组中19.44%（n = 28）的患者患有低钠血症。在低能量创伤导致骨折的组中，65岁以上患者的低钠血症比例与年轻患者相比显著增加（* = 0.0016）。此外，低钠血症组中无显著性别差异。在28例慢性低钠血症患者中，所有患者的骨质均下降。4例患者表现为骨质减少，另外24例患者甚至表现为骨质疏松。在低能量创伤组中，BMD与血清钠显著相关（r = 0.396；**<0.001）。结果表明，慢性低钠血症会影响骨质。由于骨质下降，慢性低钠血症患者在低能量创伤后骨折的患病率增加。因此，不同专业的医生应关注慢性低钠血症的治疗，以降低低能量创伤后的骨折发生率，尤其是老年患者。
