@article{ref1,
title="Sub-acute more than chronic hyponatremia is associated with serious falls and hip fractures",
journal="Internal medicine journal",
year="2019",
author="Bhandari, Simran K. and Adams, Annette L. and Li, Bonnie H. and Rhee, Connie M. and Sundar, Shirin and Krasa, Holly and Danforth, Kim N. and Kanter, Michael H. and Kalantar-Zadeh, Kamyar and Jacobsen, Steven J. and Sim, John J.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Falls and hip fractures among older people are associated with high morbidity and mortality. Hyponatremia may be a risk for falls/hip fractures, but the effect of hyponatremia duration is not well understood. AIMS: We sought to evaluate individuals with periods of sub-acute and chronic hyponatremia on subsequent risk for serious falls and/or hip fractures. <br><br>METHODS: Retrospective cohort study in the period 1/1/1998-6/14/2016 within an integrated health system of individuals aged ≥55 years with ≥2 outpatient serum sodium measurements. Hyponatremia was defined as sodium <135 mEq/L with sub-acute (<30 days) and chronic (>/=30 days) and analyzed as a time-dependent exposure. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios (HRs) for serious falls/hip fractures based on sodium category. <br><br>RESULTS: Among 1 062 647 individuals totaling 9 762 305 sodium measurements, 96 096 serious falls/hip fracture events occurred. Incidence (per-1000-person-years) of serious falls/hip fractures were 11.5, 27.9, and 19.8 for normonatremia, sub-acute, and chronic hyponatremia. Any hyponatremia duration compared to normonatremia had a serious falls/hip fractures HR (95%CI) of 1.18(1.15, 1.22), with sub-acute and chronic hyponatremia having HRs of 1.38(1.33, 1.42) and 0.91(0.87, 0.95), respectively. Examined separately, the serious falls HR was 1.37(1.32, 1.42) and 0.92(0.88, 0.96) in sub-acute and chronic hyponatremia, respectively. Hip fracture HRs were 1.52(1.42, 1.62) and 1.00(0.92, 1.08) for sub-acute and chronic hyponatremia, respectively, compared to normonatremia. <br><br>CONCLUSIONS: Our findings suggest that early/sub-acute hyponatremia appears more vulnerable and associated with serious falls/hip fractures. Whether hyponatremia is a marker of frailty or a modifiable risk factor for falls remains to be determined. This article is protected by copyright. All rights reserved.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1444-0903",
doi="10.1111/imj.14684",
url="http://dx.doi.org/10.1111/imj.14684"
}