Fracture risk after thiazide-associated hyponatraemia

Area of Science:

• Nephrology
• Endocrinology
• Geriatrics

Background:

• Thiazide diuretics promote calcium balance but can cause hyponatraemia.
• Hyponatraemia has been recently associated with an increased risk of fractures.
• The relationship between thiazide-induced hyponatraemia and fracture risk requires further investigation.

Purpose of the Study:

• To examine the association between thiazide-induced hyponatraemia and the risk of developing osteoporotic fractures.
• To identify independent predictors of fracture risk in patients using thiazide diuretics.

Main Methods:

• A single-center retrospective study analyzing a cohort of patients with and without thiazide-induced hyponatraemia.
• Follow-up of 439 patients (223 with hyponatraemia, 216 without) over a mean period of 82 months.
• Univariate and Cox proportional hazards regression analyses were performed to assess fracture risk.

Main Results:

• 61 osteoporotic fractures were recorded during the follow-up period.
• Univariate analysis suggested a higher hazard ratio for fracture in patients with thiazide-induced hyponatraemia (1.78).
• Multivariate analysis identified age, body mass index, and diabetes mellitus as the sole independent predictors of fractures, with no significant association for hyponatraemia history.

Conclusions:

• The initial association between thiazide-induced hyponatraemia and osteoporotic fracture risk observed in univariate analysis was not supported by multivariate analysis.
• Confounding factors, particularly older age and lower body mass index, likely explain the apparent increased fracture risk in patients with thiazide-induced hyponatraemia.
• A history of thiazide-induced hyponatraemia is not an independent predictor of osteoporotic fractures.