Cargando…
Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control
CONTEXT: Patients with diabetes mellitus are at increased risk for bone fragility fracture secondary to multiple mechanisms. Hyperglycemia can induce true dilutional hyponatremia. Hyponatremia is associated with gait instability, osteoporosis, and increased falls and bone fractures, and studies sugg...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Endocrine Society
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364625/ https://www.ncbi.nlm.nih.gov/pubmed/30746503 http://dx.doi.org/10.1210/js.2018-00320 |
_version_ | 1783393302625648640 |
---|---|
author | Usala, Rachel L Fernandez, Stephen J Mete, Mihriye Shara, Nawar M Verbalis, Joseph G |
author_facet | Usala, Rachel L Fernandez, Stephen J Mete, Mihriye Shara, Nawar M Verbalis, Joseph G |
author_sort | Usala, Rachel L |
collection | PubMed |
description | CONTEXT: Patients with diabetes mellitus are at increased risk for bone fragility fracture secondary to multiple mechanisms. Hyperglycemia can induce true dilutional hyponatremia. Hyponatremia is associated with gait instability, osteoporosis, and increased falls and bone fractures, and studies suggest that compromised bone quality with hyponatremia may be independent of plasma osmolality. We performed a case-control study of patients with diabetes mellitus matched by median glycated hemoglobin (HbA1c) to assess whether hyponatremia was associated with increased risk of osteoporosis and/or fragility fracture. DESIGN: Osteoporosis (n = 823) and fragility fracture (n = 840) cases from the MedStar Health database were matched on age of first HbA1c ≥6.5%, sex, race, median HbA1c over an interval from first HbA1c ≥6.5% to the end of the encounter window, diabetic encounter window length, and type 1 vs type 2 diabetes mellitus with controls without osteoporosis (n = 823) and without fragility fractures (n = 840), respectively. Clinical variables, including coefficient of glucose variation and hyponatremia (defined as serum [Na(+)] <135 mmol/dL within 30 days of the end of the diabetic window), were included in a multivariate analysis. RESULTS: Multivariate conditional logistic regression models demonstrated that hyponatremia within 30 days of the outcome measure was independently associated with osteoporosis and fragility fractures (osteoporosis OR 3.09; 95% CI, 1.37 to 6.98; fracture OR, 6.41; 95% CI, 2.44 to 16.82). CONCLUSIONS: Our analyses support the hypothesis that hyponatremia is an additional risk factor for osteoporosis and fragility fracture among patients with diabetes mellitus. |
format | Online Article Text |
id | pubmed-6364625 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Endocrine Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-63646252019-02-11 Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control Usala, Rachel L Fernandez, Stephen J Mete, Mihriye Shara, Nawar M Verbalis, Joseph G J Endocr Soc Clinical Research Articles CONTEXT: Patients with diabetes mellitus are at increased risk for bone fragility fracture secondary to multiple mechanisms. Hyperglycemia can induce true dilutional hyponatremia. Hyponatremia is associated with gait instability, osteoporosis, and increased falls and bone fractures, and studies suggest that compromised bone quality with hyponatremia may be independent of plasma osmolality. We performed a case-control study of patients with diabetes mellitus matched by median glycated hemoglobin (HbA1c) to assess whether hyponatremia was associated with increased risk of osteoporosis and/or fragility fracture. DESIGN: Osteoporosis (n = 823) and fragility fracture (n = 840) cases from the MedStar Health database were matched on age of first HbA1c ≥6.5%, sex, race, median HbA1c over an interval from first HbA1c ≥6.5% to the end of the encounter window, diabetic encounter window length, and type 1 vs type 2 diabetes mellitus with controls without osteoporosis (n = 823) and without fragility fractures (n = 840), respectively. Clinical variables, including coefficient of glucose variation and hyponatremia (defined as serum [Na(+)] <135 mmol/dL within 30 days of the end of the diabetic window), were included in a multivariate analysis. RESULTS: Multivariate conditional logistic regression models demonstrated that hyponatremia within 30 days of the outcome measure was independently associated with osteoporosis and fragility fractures (osteoporosis OR 3.09; 95% CI, 1.37 to 6.98; fracture OR, 6.41; 95% CI, 2.44 to 16.82). CONCLUSIONS: Our analyses support the hypothesis that hyponatremia is an additional risk factor for osteoporosis and fragility fracture among patients with diabetes mellitus. Endocrine Society 2019-01-04 /pmc/articles/PMC6364625/ /pubmed/30746503 http://dx.doi.org/10.1210/js.2018-00320 Text en Copyright © 2019 Endocrine Society https://creativecommons.org/licenses/by-nc-nd/4.0/ This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Articles Usala, Rachel L Fernandez, Stephen J Mete, Mihriye Shara, Nawar M Verbalis, Joseph G Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control |
title | Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control |
title_full | Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control |
title_fullStr | Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control |
title_full_unstemmed | Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control |
title_short | Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control |
title_sort | hyponatremia is associated with increased osteoporosis and bone fractures in patients with diabetes with matched glycemic control |
topic | Clinical Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364625/ https://www.ncbi.nlm.nih.gov/pubmed/30746503 http://dx.doi.org/10.1210/js.2018-00320 |
work_keys_str_mv | AT usalarachell hyponatremiaisassociatedwithincreasedosteoporosisandbonefracturesinpatientswithdiabeteswithmatchedglycemiccontrol AT fernandezstephenj hyponatremiaisassociatedwithincreasedosteoporosisandbonefracturesinpatientswithdiabeteswithmatchedglycemiccontrol AT metemihriye hyponatremiaisassociatedwithincreasedosteoporosisandbonefracturesinpatientswithdiabeteswithmatchedglycemiccontrol AT sharanawarm hyponatremiaisassociatedwithincreasedosteoporosisandbonefracturesinpatientswithdiabeteswithmatchedglycemiccontrol AT verbalisjosephg hyponatremiaisassociatedwithincreasedosteoporosisandbonefracturesinpatientswithdiabeteswithmatchedglycemiccontrol |