Korean J Fam Pract. 2017; 7(2): 228-232  https://doi.org/10.21215/kjfp.2017.7.2.228
Relationship between Asymptomatic Hyponatremia with Fracture in Elderly
Hyun Jung Choi, Jung Im Gwak*, Jun Seob Shin, Ji Wan Nam, So Jung Yun, Hyung Joon An
Department of Family Medicine, Anyang SAM General Hospital, Anyang, Korea
Jung Im Gwak
Tel: +82-31-467-9161, Fax: +82-31-449-0151
E-mail: euridiche@hanmail.net
Received: March 12, 2016; Revised: August 4, 2016; Accepted: August 19, 2016; Published online: April 20, 2017.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Asymptomatic hyponatremia is an electrolyte imbalance that occurs frequently in the elderly. It is associated with mild cognitive impairment, which results in gait disturbances and a higher frequency of falls. The association between mild hyponatremia and fractures remains unknown.
Methods: We performed a case-control study between January 2014 and November 2015. The cases were 512 ambulatory patients aged 65 years or older who had been admitted to the hospital after sustaining a fracture secondary to an incidental fall. Another 512 ambulatory patients without any previous fractures were enrolled as age- and sex- matched controls.
Results: There were a total of 1,024 age- and sex-matched subjects. The serum sodium level was lower in the fracture group than in the non-fracture group (P<0.001). The prevalence of hyponatremia (serum sodium <135 mEq/L) was 8.0% in patients with fractures, and 3.9% in the control group (P=0.006). Hyponatremia was mild and asymptomatic in all patients, and was an independent risk factor for sustaining a fracture after an accidental fall (odds ratio 2.076, 95% confidence interval=1.124-3.833; P<0.001).
Conclusion: Asymptomatic hyponatremia is associated with fractures in the ambulatory elderly population. Treating hyponatremia and avoiding drug-induced hyponatremia may reduce the risk of fractures in the elderly.
Keywords: Elderly; Accidental Falls; Fracture; Hyponatremia
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