THE EFFECTS OF HYPONATREMIA ON BONE DENSITY AND FRACTURES: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Objective: Hyponatremia decreases bone mineral density and is a major risk factor for fragility fractures. Objectives of our systematic review and meta-analysis were to analyze the overall effects of hyponatremia on bone fractures, osteoporosis, and mortality. Methods: We extracted data from Medline, Cochrane Central, and EMBASE 1960-2017 and conference abstracts from 2007-2017. We included studies with data on serum sodium, fractures, bone density, or diagnoses of osteoporosis. Studies were independently reviewed by two authors and assessed for bias using the Newcastle-Ottawa scale. Random effect models meta-analysis was used when at least three studies reported the same outcome measures. We reported summary odds ratios (ORs) and 95% confidence intervals (CIs). Results: We included 26 studies for qualitative analysis. Fifteen studies were included in the meta-analysis to evaluate the effects of hyponatremia on fractures, four studies for bone mineral density changes, and six for mortality. Hyponatremia increased the odds of fractures at all sites (summary OR, 2.34 [95% CI, 1.86, 2.96]. There was an increase in the odds of osteoporosis (summary OR, 2.67 [95% CI, 2.07, 3.43]). Mortality risk among the included studies remained high (summary OR, 1.31 [95% CI, 1.16, 1.47]). Conclusion: Our meta-analysis confirms a statistically significant association of hyponatremia with bone fractures and osteoporosis along with higher mortality. Long-term prospective studies evaluating the impact of correcting hyponatremia on bone health, fractures, and mortality are required. Abbreviations: AVP = arginine vasopressin; CI = confidence interval; CKD = chronic kidney disease; OR = odds ratio; SIADH = syndrome of inappropriate antidiuretic hormone.

Parathyroid hormone resistance from severe hypomagnesaemia caused by cisplatin.

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Prevalence of cardiovascular risk factors in erectile dysfunction.

OBJECTIVE: Thirty million men in the United States may have erectile dysfunction, and coronary artery disease (CAD) is the major cause of death in men over 55 years old. Several studies have shown a correlation between erectile dysfunction and risk factors for coronary artery disease. Hyperlipidemia plays a pivotal role in CAD, and obesity is now considered an independent risk factor for CAD. Therefore, we attempted to determine the prevalence of obesity and hyperlipidemia, along with other established risk factors such as diabetes, hypertension, and tobacco use, in men with erectile dysfunction. METHODS: Men who had had symptoms of erectile dysfunction for at least six months were recruited from the Center for Sexual Function. Participants underwent detailed clinical interviews, blood analyses, and physical examinations including calculation of body mass index, and they completed a questionnaire on sexual function. RESULTS: Of the 154 men evaluated, 44% had hypertension; 23% had diabetes mellitus; 16% used tobacco; 79% had a body mass index of > 26 kg/m2; and 74% had a low-density lipoprotein cholesterol level of > 120 mg/dL. CONCLUSION: Impotence is an important symptom, and its presence should instigate assessment and aggressive management of coexistent risk factors for CAD. Intervention could restore sexual function and ultimately improve cardiovascular health.