Hyponatremia-induced osteoporosis

Joseph G. Verbalis, Julianna Barsony, Yoshihisa Sugimura, Ying Tian, Douglas J. Adams, Elizabeth A. Carter, Helaine E. Resnick

Research output: Contribution to journalArticle

250 Citations (Scopus)

Abstract

There is a high prevalence of chronic hyponatremia in the elderly, frequently owing to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Recent reports have shown that even mild hyponatremia is associated with impaired gait stability and increased falls. An increased risk of falls among elderly hyponatremic patients represents a risk factor for fractures, which would be further amplified if hyponatremia also contributed metabolically to bone loss. To evaluate this possibility, we studied a rat model of SIADH and analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). In rats, dual-energy X-ray absorptiometry (DXA) analysis of excised femurs established that hyponatremia for 3 months significantly reduced bone mineral density by approximately 30% compared with normonatremic control rats. Moreover, micro-computed tomography (μCT) and histomorphometric analyses indicated that hyponatremia markedly reduced both trabecular and cortical bone via increased bone resorption and decreased bone formation. Analysis of data from adults in NHANES III by linear regression models showed that mild hyponatremia is associated with increased odds of osteoporosis (T-score -2.5 or less) at the hip [odds ratio (OR) = 2.85; 95% confidence interval (CI) 1.03-7.86; p < .01]; all models were adjusted for age, sex, race, body mass index (BMI), physical activity, history of diuretic use, history of smoking, and serum 25-hydroxyvitamin D [25(OH)D] levels. Our results represent the first demonstration that chronic hyponatremia causes a substantial reduction of bone mass. Cross-sectional human data showing that hyponatremia is associated with significantly increased odds of osteoporosis are consistent with the experimental data in rodents. Our combined results suggest that bone quality should be assessed in all patients with chronic hyponatremia.

Original languageEnglish
Pages (from-to)554-563
Number of pages10
JournalJournal of Bone and Mineral Research
Volume25
Issue number3
DOIs
Publication statusPublished - 01-01-2010

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Hyponatremia
Osteoporosis
Nutrition Surveys
Inappropriate ADH Syndrome
Bone and Bones
Linear Models
Photon Absorptiometry
Bone Resorption
Gait
Diuretics
Osteogenesis
Bone Density
Femur
Hip
Rodentia
Body Mass Index
Smoking
Odds Ratio
Tomography
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Verbalis, J. G., Barsony, J., Sugimura, Y., Tian, Y., Adams, D. J., Carter, E. A., & Resnick, H. E. (2010). Hyponatremia-induced osteoporosis. Journal of Bone and Mineral Research, 25(3), 554-563. https://doi.org/10.1359/jbmr.090827
Verbalis, Joseph G. ; Barsony, Julianna ; Sugimura, Yoshihisa ; Tian, Ying ; Adams, Douglas J. ; Carter, Elizabeth A. ; Resnick, Helaine E. / Hyponatremia-induced osteoporosis. In: Journal of Bone and Mineral Research. 2010 ; Vol. 25, No. 3. pp. 554-563.
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Verbalis, JG, Barsony, J, Sugimura, Y, Tian, Y, Adams, DJ, Carter, EA & Resnick, HE 2010, 'Hyponatremia-induced osteoporosis', Journal of Bone and Mineral Research, vol. 25, no. 3, pp. 554-563. https://doi.org/10.1359/jbmr.090827

Hyponatremia-induced osteoporosis. / Verbalis, Joseph G.; Barsony, Julianna; Sugimura, Yoshihisa; Tian, Ying; Adams, Douglas J.; Carter, Elizabeth A.; Resnick, Helaine E.

In: Journal of Bone and Mineral Research, Vol. 25, No. 3, 01.01.2010, p. 554-563.

Research output: Contribution to journalArticle

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Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA et al. Hyponatremia-induced osteoporosis. Journal of Bone and Mineral Research. 2010 Jan 1;25(3):554-563. https://doi.org/10.1359/jbmr.090827