The Influence of Hyponatremia and Hypokalemia on the Risk of Fractures in Various Anatomical Regions among Adult Trauma Patients: A Propensity Score-Matched Analysis

TL;DR

This study finds that low sodium levels in trauma patients increase the risk of certain fractures, while low potassium levels have a smaller impact.

Contribution

The study is the first to use propensity score-matching to compare fracture risks in trauma patients with hyponatremia and hypokalemia.

Findings

Hyponatremia increases the odds of thoracic vertebral, pelvic, and femoral fractures.

Hypokalemia is not significantly associated with most fractures but decreases radial fracture risk.

Patients with both hyponatremia and hypokalemia show reduced risk of radial and patella fractures.

Abstract

Background: Hyponatremia and hypokalemia are common electrolyte imbalances in trauma patients and have been identified to be risk factors for a fall. In addition, hyponatremia was reported to be related to osteoporosis and fragility fractures, while the association between hypokalemia and osteoporosis has only been reported in rare case reports. This study investigated the impact of hyponatremia and hypokalemia on the incidence of fractures in various body regions of adult trauma patients, using the propensity score-matched patient cohort to reduce the influence of patients’ baseline characteristics. Methods: The study analyzed data from 11,173 hospitalized adult trauma patients treated from 1 January 1998, to 31 December 2022. The study included 1968 patients with hyponatremia and 9205 without, and 1986 with hypokalemia and 9187 without. Different 1:1 propensity score-matched cohorts were generated to create the 1903 pairings of patients with or without hyponatremia, 1977 pairings of patients with or without hypokalemia, and 380 pairing of patients with both hyponatremia and hypokalemia vs. normal control patients. Analysis was conducted on the incidence of fracture in various anatomic regions. Results: Hyponatremic patients had increased odds of thoracic vertebral fracture [odds ratio (95% confidence interval) 1.63 (1.10–2.42), p = 0.014], pelvic fracture [2.29 (1.12–4.67), p = 0.019], and femoral fracture [1.28 (1.13–1.45), p < 0.001] but decreased odds of radial and patella fractures. Hypokalemic patients showed no significant differences in fracture risk except for a decreased likelihood of radial fractures. The patients with both hyponatremia and hypokalemia showed a decreased likelihood of radial fractures and patella fractures. Conclusion: Hyponatremia may have a greater impact on the occurrence of bone fractures than hypokalemia in trauma patients who have suffered a fall. Electrolyte abnormalities should be taken into account while assessing the risk of fractures in trauma patients.

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