Osteoporotic Fractures in Patients with Hyponatremia

Researchers in Switzerland recently reported on the association between hyponatremia, diuretic use, and osteoporotic fractures in the emergency setting.

The authors of “Diuretic-Induced Hyponatremia and Osteoporotic Fractures in Patients Admitted to the Emergency Department,” published in Maturitas, performed a retrospective case series analysis of prospectively gathered data from nearly 11,000 patients (10,823) age 50 years and older whose serum sodium levels were measured upon admission to the hospital.

Outcomes from 480 patients (5% of the total cohort) who presented with osteoporotic fractures (OF) were compared to a control group that did not have OF. The researchers reported that the OF group was older (average age of 73 years vs. 68 years), had proportionally fewer men (37% vs. 58%), had a much higher hospitalization rate (83% vs. 62%), and tended to stay in the hospital longer (8 days vs. 6 days).

Compared to controls, the OF group was significantly more likely to use any diuretic agent, loop diuretics, spironolactone, and amiloride, but not thiazides.

The authors reported that hyponatremia prevalence “increased significantly” with the number of diuretics taken. Patients who were older, who used only the loop diuretic furosemide, who had hyponatremia, who were treated with amiloride in addition to other diuretics, and/or who had higher serum creatinine were at higher risk for osteoporotic fractures.

According to the authors, these study results highlight “the clinical association of hyponatremia during the use of certain diuretics (ie, furosemide or in combination, ie, amiloride) with an increased risk of osteoporosis-associated fractures. Although evidence-based data is currently lacking, a pragmatic approach concerning hyponatremia monitoring and correction appears reasonable in selected groups of patients.”