Associations Between Hyponatremia, Serum Osmolality, and Bone Health in Individuals With Diabetes Mellitus: Analysis of NHANES, 2005–2010
Jui-Chu Huang, Meng-Huang Wu, Sung Huang Laurent Tsai, Pey-Jium Chang, Evelyn Jou-Chen Huang, Tsung-Jen Huang, Ching-Yu LeeBackground
Diabetes mellitus (DM) is associated with increased fracture risk despite normal or elevated bone mineral density. Hyponatremia, a common electrolyte imbalance among older adults, has been linked to reduced bone mineral density and higher fracture risk in the general population. This study evaluated associations between hyponatremia, serum osmolality, and bone mineral density in community‐dwelling adults with DM.
Methods
This cross‐sectional, observational study included data of adults aged ≥ 55 years with DM extracted from NHANES, 2005–2010. Those with hypernatremia or missing data were excluded. Proximal femur bone mineral density was assessed via dual‐energy X‐ray absorptiometry (DXA), and serum sodium (Na) and osmolality were measured using a single blood sample obtained at survey entry. Hyponatremia was defined as a serum Na level < 135 mmol/L. Logistic regression analyses were performed to evaluate the associations between hyponatremia, serum osmolality, and osteoporosis/osteopenia.
Results
Data from 1365 patients with DM (mean age: 68 years) were extracted from NHANES and included in the analysis. Patients with hyponatremia had significantly higher odds of osteoporosis/osteopenia (adjusted odds ratio [aOR] = 3.33, 95% CI: 1.43–7.77, p = 0.006). Serum osmolality was not significantly associated with osteoporosis/osteopenia. In exploratory subgroup analyses, statistically significant associations between hyponatremia and low BMD were observed in individuals without CVD or CKD and in those with glycated hemoglobin (HbA1c) ≥ 7.5%.
Conclusions
Hyponatremia, but not serum osmolality, was independently associated with higher odds of osteoporosis/osteopenia in community‐dwelling adults with DM in the United States. Further longitudinal studies in prospective cohorts are warranted to clarify the temporal relationship and the consideration of clinical implementation or screening use.