Men's Osteoporosis Support GroupHyponatremia and fracture risk; bisphosponates and atrial fibrillation; podcast and book Clin J Am Soc Nephrol. 2010 Jan 7. [Epub ahead of print]. Hyponatremia Independent of Osteoporosis is Associated with Fracture Occurrence. Kinsella S and others. PMID: 20056759. Mild hyponatremia, a condition of low sodium in the body fluids, was tested in this study as a possible cause of increased fracture risk. The study involved 1408 consecutive female patients who underwent bone mineral density testing (DXA) and had available lab data. Mild hyponatremia was determined to be a result less than 135 mmol/L. Forty-five percent of the women had osteoporosis and 18% had fractured before having the DXA. The authors found, "Hyponatremia was present in 8.7% of those with versus 3.2% of those without a confirmed fracture (P < 0.001)." Even when adjusting for multiple other parameters, "[Hyponatremia] remained significantly and independently associated with fracture occurrence (P < 0.01)." The study concluded, "Mild hyponatremia may be a readily identifiable and potentially modifiable risk factor for fracture." Editor's comments: Note in the Related Articles there is a 2008 study that came to similar conclusions regarding fracture risk and mild hyponatremia. See QJM. 2008 Jul;101(7):583-8. Epub 2008 May 13. Mild hyponatremia and risk of fracture in the ambulatory elderly. Gankam Kengne F and others. PMID: 18477645. What this means is that hyponatremia appears to be a significant risk for fracture notwithstanding bone mineral density (BMD), or other factors. So if you are told you have hyponatremia, even though it is considered mild, it is imperative to have that corrected to normal levels in order to decrease the risk of fracture. This study included only women so it isn't known for sure if men are at increased fracture risk from hyponatremia, but it is best to assume so until proven otherwise. Int J Cardiol. 2010 Jan 3. [Epub ahead of print]. Bisphosphonate use in women and the risk of atrial fibrillation: A systematic review and meta-analysis. Bhuriya R and others. PMID: 200511297. This is another study on the topic of atrial fibrillation in those taking bisphosphonates for osteoporosis that was done as a meta-analysis. Four studies with 26126 postmenopausal women were included in the meta-analysis. The results showed, "Meta-analysis revealed that serious atrial fibrillation occurred more frequently in the bisphosphonate group compared to the placebo group (RR 1.525; 95% CI, 1.166 to 1.997; p=0.002)." The authors concluded, "Bisphosphonate use is associated with a significant increase in the risk of serious atrial fibrillation in postmenopausal women." Editor's comments. This is yet again another osteoporosis-related study that involved only women, so it is uncertain if the results apply equally to men. A recent Update involved more than 47,000 consecutive patients undergoing angiography, presumably both men and women. The results showed no relationship between bisphosphonate use and atrial fibrillation. There are links on that Update page to other studies I've reviewed on this topic of atrial fibrillation. For now the results are still inconclusive, although it would be wise to assume there is some increased risk of atrial fibrillation for those on bisphosphonates until further studies can clarify that risk level, if it exists, with greater certainty. Checklists. Although not specifically related to osteoporosis, I heard an interesting podcast recently on the topic of improving hospital and medical/surgical safety and other outcomes via the use of checklists. It was on The Diane Rehm Show (scroll down to the 11:00 show) as an interview with the author of a recent book on this topic, "The Checklist Manifesto: How to Get Things Right," by Atul Gawande. Dr. Gawande cited several instances where using check lists improved safety during surgery, improved outcomes, decreased both complications and hospital admission rates, etc. After listening to the podcast, or reading the book, my guess is you will want to know that your surgeon or hospital is using these checklists. That is not the case yet as only about 20% of hospitals are doing so currently according to Dr. Gawande.
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