Severe osteoporosis – the story of chronic medication-related hyponatremia
Authors:
Pavel Polák 1,2,3; Petr Husa 1; Hana Matějovská Kubešová 2
Authors‘ workplace:
Klinika infekčních chorob LF MU a FN Brno
1; Klinika interní, geriatrická, ošetřovatelství a praktického lékařství LF MU a FN Brno
2; Oddělení klinické hematologie FN Brno
3
Published in:
Vnitř Lék 2016; 62(2): 152-156
Category:
Case Reports
Overview
The authors present a case-report of a 73years old woman treated for arterial hypertension within past 15 years with diuretics (thiazides, amiloride and indapamide) and concomitantly with antidepressive trazodone. The patient developed severe osteoporosis after 6 years of such a treatment with multiple fractures even after minor trauma; during whole this period severe hyponatremia without adequate supplementation was documented. Most probably, there exists tight relationship of osteoporosis and hyponatremia in this patient – the authors discuss possible pathophysiological mechanisms at the level of renal tubules, osteoblasts and osteoclasts, hypopituitary-skeletal axis, syndrome of inadequate adiuretin secretion (SIADH) and possible influence of acid-base balance disturbances.
Key words:
alkalosis – antidepressive drugs – diuretics – hyponatremia – osteoporosis
Sources
1. Sakhaee K, Maalouf NM, Kumar R et al. Nephrolithiasis-associated bone disease: pathogenesis and treatment options. Kidney Int 2011; 79(4): 393–403.
2. Ayus JC, Negri AL, Kalantar-Zadeh K et al. Is chronic hyponatremia a novel risk factor for hip fracture in the elderly? Nephrol Dial Transplant 2012; 27(10): 3725–3731.
3. Žofková I. Léky indukovaná osteoporóza. Vnitř Lék 2013; 59(1): 59–63.
4. Vestergaard P, Rejnmark L, Mosekilde L. Hypertension is a risk factor for fractures. Calcif Tissue Int 2009; 84(2): 103–111.
5. Javed F, Khan SA, Ayers EW et al. Association of hypertension and bone mineral density in an elderly African American female population. J Natl Med Assoc 2012; 104(3–4): 172–178.
6. Aluoch AO, Jessee R, Habal H et al. Heart failure as a risk factor for osteoporosis and fractures. Curr Osteoporos Rep 2012; 10(4): 258–269.
7. Ilić K, Obradović N, Vujasinović-Stupar N. The relationship among hypertension, antihypertensive medications, and osteoporosis: a narrative review. Calcif Tissue Int 2013; 92(3): 217–227.
8. Kann PH, Hadji P, Bergmann RS. Osteoporose jenseits von Kortison. Z Rheumatol 2014; 73(4): 323–328.
9. Tamma R, Sun L, Cuscito C et al. Regulation of bone remodeling by vasopressin explains the bone loss in hyponatremia. Proc Natl Acad Sci USA 2013; 110(46): 18644–18649. Dostupné z DOI: http://dx.doi.org/10.1073/pnas.1318257110.
10. Hannon MJ, Verbalis JG. Sodium homeostasis and bone. Curr Opin Nephrol Hypertens 2014; 23(4): 370–376.
11. Lawson EA, Fazeli PK, Calder G et al. Plasma sodium level is associated with bone loss severity in women with anorexia nervosa: a cross-sectional study. J Clin Psychiatry 2012; 73: e1379-e1383. Dostupné z DOI: http://dx.doi.org/10.4088/JCP.12m07919.
12. Hoorn EJ, Rivadeneira F, van Meurs JBJ et al. Mild hyponatremia as a risk factor for fractures: The Rotterdam Study. J Bone Miner Res 2011; 26(8): 1822–1828.
13. Miriam Rachel Usala G, Fernandez SJ, Mete M et al. Hyponatremia is associated with increased osteoporosis and bone fractures in a large U. S. health system population. J Clin Endocrinol Metab 2015; 100(8):3021–3031. Dostupné z DOI: http://dx.doi.org/10.1210/jc.2015–1261.
14. Kruse C, Eiken P, Vestergaard P. Hyponatremia and osteoporosis: insights from the Danish National Patient Registry. Osteoporos Int 2015; 26(3): 1005–1016.
15. Kwak MK, Choi D, Lee JH et al. Relationship between decrease in serum sodium level and bone mineral density in osteoporotic fracture patients. J Bone Metab 2015; 22(1): 9–15.
16. Afshinnia F, Sundaram B, Ackermann RJ et al. Hyponatremia and osteoporosis: reappraisal of a novel association. Osteoporos Int 2015; 26(9): 2291–2298.
17. Li WG, Yu Y, Huang C et al. Nonproton ligand sensing domain is required for paradoxical stimulation of acid-sensing ion channel 3 (ASIC3) channels by amiloride. J Biol Chem 2011; 286(49): 42635–42646. Dostupné z DOI: http://dx.doi.org/10.1074/jbc.M111.289058.
18. Weinstein AM. A mathematical model of distal nephron acidification: diuretic effects. Am J Physiol Renal Physiol 2008; 295(5): F1353-F1364.
19. Kopp KF. Das Bikarbonat-Mangel-Syndrom, Bicarbonate-Deficiency-Syndrome (BDS). Der Bikarbonat-Alkalisch-Plus-BONUS (BBAPB). Tägliche Bikarbonat-Substitution, Wirkung und Nutzen für Wohlbefinden und Gesundheit im Allgemeinen und in der Medizin. Dostupné z WWW: http://www.kf-kopp.de/wissenschaftliche-arbeiten/das-bikarbonat-mangel-syndrom-bicarbonate-deficiencysyndrome-bds/.
20. Bhuvaneswar CG, Baldessarini RJ, Harsh VL et al. Adverse endocrine and metabolic effects of psychotropic drugs: selective clinical review. CNS Drugs 2009; 23(12): 1003–1021.
21. Bonny O, Edwards A. Calcium reabsorption in the distal tubule: regulation by sodium, pH, and flow. Am J Physiol Renal Physiol 2013; 304(5): F585-F600.
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Diabetology Endocrinology Internal medicineArticle was published in
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