title: Hyponatremia and osteoporosis: reappraisal of a novel association.
abstract: Age was a modifier of the independent association between hyponatremia and osteoporosis (OP). Risk of OP was the highest in the youngest age group as compared to older patients. A longer duration of hyponatremia revealed a similar association with OP in all anatomical sites.
  
  
  BACKGROUND
  Epidemiologic studies provide conflicting results on the relationship between hyponatremia and OP. Our aim is to test the modification effect of age on the relationship between hyponatremia and OP at various anatomical sites in a large patient population.
  
  
  METHODS
  This is a cross-sectional observation of consecutive patients with available bone densitometry, demographic, clinical, and laboratory data from 2001 to 2013 at a single center. OP was defined as a bone mineral density of ≤2.5 standard deviations below the mean peak bone mass of young, healthy adults. Hyponatremia was defined as serum sodium ≤135 mmol/L. Multiple logistic regressions were used to calculate adjusted odds ratio (OR).
  
  
  RESULTS
  Overall, 24,784 patients were included. There were 4549 males (18.4 %). Hyponatremia was present in 703 patients (2.8 %), femoral neck OP in 2603 (10.5 %), total hip OP in 1885 (7.5 %), and lumbar OP in 4830 (19.5 %). Total hip OP occurred in 17.6 % (n = 124) of patients with hyponatremia as compared to 6.6 % (n = 880) of patients with sodium level of "140-145" mmol/L (P < 0.001). After multivariable adjustments, hyponatremia was associated with 2.46-fold higher odds of total hip OP (95 % CI, 1.36 to 4.46) in age <55 years, 1.96-fold (1.13 to 3.41) in age 55 to 67 years, and 1.55-fold (1.13 to 2.12) in age >67 years (age-sodium category interaction P value = 0.002).
  
  
  CONCLUSIONS
  Age appeared as a modifier of the independent association between hyponatremia and OP. Risk of OP was the highest in the youngest age group as compared to older patients.
authors: Division of Nephrology, Department of Internal Medicine, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr., SPC 5364, Ann Arbor, MI, 48109, USA, fafshin@med.umich.edu.
authors: F
authors: F
authors: Afshinnia
authors: B
authors: B
authors: Sundaram
authors: R J
authors: RJ
authors: Ackermann
authors: K K
authors: KK
authors: Wong
mesh_terms: D000367:Age Factors; D000368:Aged; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007010:Hyponatremia / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors