Association of hyponatremia and osteoporosis by analyzing serum sodium levels in elderly intertrochanteric fracture patients by Beckman coulter machine

Introduction: Hyponatremia is the most common electrolyte disorder seen in clinical practice, it is defined as a serum sodium concentration of less than 135 mmol/L, and there is accumulating evidence that even mild hyponatremia is associated with increased morbidity and mortality, furthermore it can be a novel marker for fracture risk. Materials and Methods: The study was conducted in department of orthopaedics, S.R.G. Hospital and Medical College, Jhalawar (Rajasthan). The study comprised of 78 patients (48 males and 30 females) with intertrochanteric fractures. Observations and Results: Out of total 78 patients taken in study 61 were found to be hyponatremic. Out of 48 males in study 39 were hyponatremic, and out of 30 females 22 were hyponatremic.


Introduction
Hyponatremia is most common electrolyte disorder seen in clinical practices, 1 it is defined as a serum sodium concentration of <135 mmol/L, and there is evidence that mild hyponatremia are associated with increased morbidity and mortality, 2-5 furthermore it can be a novel marker for fracture risk.
Studies demonstrate that a large amount of body sodium is stored in bone matrix 6 suggesting that bone may serve as a mobilize of sodium reservoir during periods of homeostatic stress.
My Study indicate that acute hyponatremia can induce a wide spectrum of neurological deficits, ranging from mild symptoms to more significant disorders. The neurological dysfunctions associated with hyponatremia have been shown to include gait instability 9 and fall on ground, 10,11 both of which could compound patient fracture risk.
My study aims to contribute to data concerning hyponatremia and fractures by determining the relationships between hyponatremia and fractures among a cohort of elderly patients presenting to S.R.G. Hospital, Jhalawar, Rajasthan, India with intertrochanteric fractures considering these fractures to be direct result of decreased bone mineral density.

Materials and Methods Subjects
The study was conducted in department of orthopaedics, S.R.G. Hospital and Medical College, Jhalawar (Rajasthan

Serum Sodium Assessment
Fasting serum was obtained at the baseline visit in all patients. Serum sodium was measured on thawed serum at the institute's central laboratory using a Beckman Coulter Machine.

Observations and Result
Out of total 78 patients taken in study 61 were found to be hyponatremic.
Out of 48 males in study 39 were hyponatremic, and out of 30 females 22 were hyponatremic.

Discussion
We found that in our study 61 patients out of 78 i.e. around 78% had serum sodium levels < 135 mmol/L. Our results are consistent with previous studies that have reported on associations between hyponatremia and fractures. A case control study identified 513 cases of hip region fractures after a fall and fracture, by about 3 fold in men and women with hyponatremia (<135mmol/L), even after giving medications and medical conditions known to confound that association between fracture and serum sodium. 12 Another second case control study reported on the prevalence of hyponatremia (<135mmol/L) among 364 subjects presenting to the hospital with fractures of the hip/pelvis and femur compared with the incidence of hyponatremia in 364 controls. Hyponatremia appears to contribute to falls and fractures by two mechanisms: 1. It produces mild cognition impairment resulting in disturbing gait and falls. 2. It directly contributes to bone demineralization and increased bone fragility by inducing increased bone resorption to mobilize sodium.

Chart 1
There is growing evidence that complications of hyponatremia include bone loss and osteoporosis, though unknown mechanism Hyponatremia can directly stimulate osteoclast genesis and osteoclastic resorption without activating of signals through osteoblasts. 14 My study had some limitations. Most importantly, it is not possible to conclude that hyponatremia causes fractures and that correcting serum sodium will reduce the risk of fractures.

Conclusion
Hip fractures in person more that >60 years are frequently caused by a sudden fall on the ground, often produced by gait disturbances due to glutamate, which are also known to be associated with sodium disturbances.