Source Paper
Hyponatremia-induced osteoporosis
Joseph G Verbalis, Julianna Barsony, Yoshihisa Sugimura, Ying Tian, Douglas J Adams et al.
Journal of Bone and Mineral Research • 2009
Source Paper
Joseph G Verbalis, Julianna Barsony, Yoshihisa Sugimura, Ying Tian, Douglas J Adams et al.
Journal of Bone and Mineral Research • 2009
Abstract There is a high prevalence of chronic hyponatremia in the elderly, frequently owing to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Recent reports have shown that even mild hyponatremia is associated with impaired gait stability and increased falls. An increased risk of falls among elderly hyponatremic patients represents a risk factor for fractures, which would be further amplified if hyponatremia also contributed metabolically to bone loss. To evaluate this possibility, we studied a rat model of SIADH and analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). In rats, dual-energy X-ray absorptiometry (DXA) analysis of excised femurs established that hyponatremia for 3 months significantly reduced bone mineral density by approximately 30% compared with normonatremic control rats. Moreover, micro-computed tomography (µCT) and histomorphometric analyses indicated that hyponatremia markedly reduced both trabecular and cortical bone via increased bone resorption and decreased bone formation. Analysis of data from adults in NHANES III by linear regression models showed that mild hyponatremia is associated with increased odds of osteoporosis (T-score –2.5 or less) at the hip [odds ratio (OR) = 2.85; 95% confidence interval (CI) 1.03–7.86; p < .01]; all models were adjusted for age, sex, race, body mass index (BMI), physical activity, history of diuretic use, history of smoking, and serum 25-hydroxyvitamin D [25(OH)D] levels. Our results represent the first demonstration that chronic hyponatremia causes a substantial reduction of bone mass. Cross-sectional human data showing that hyponatremia is associated with significantly increased odds of osteoporosis are consistent with the experimental data in rodents. Our combined results suggest that bone quality should be assessed in all patients with chronic hyponatremia. © 2010 American Society for Bone and Mineral Research.
Objective: To produce chronic hyponatremia in rats via DDAVP infusion and liquid diet to study effects on physiology compared to solid diet controls
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Obtain male albino Sprague-Dawley rats at 6 weeks old, weighing 250-300g from Taconic Farms. Measure baseline body weight.
Note: Nine rats per group were studied in experiment 1
“male albino Sprague-Dawley rats (6 weeks old, 250 to 300 g; Taconic Farms, Germantown, NY, USA)”
Surgically implant Alzet Model 2004 osmotic minipump subcutaneously to deliver DDAVP at 5 ng/h
Note: Minipumps were replaced monthly to maintain constant desmopressin levels
“infused with desmopressin (DDAVP, Aventis, Bridgewater, NJ, USA) at a rate of 5 ng/h via a subcutaneously implanted osmotic minipump (Alzet Model 2004; Durect Co., Cupertino, CA, USA)”
Begin administering 70 mL/d of nutritionally balanced rodent liquid formula (F1268SP, BioServ) at 1.0 kcal/mL via liquid diet feeding tubes (No. 9010, BioServ). This supplies 30 IU/d of vitamin D3 and 155 mg/d of calcium (5.16 g/kg).
Note: Hyponatremic groups received DDAVP and liquid diet
“fed 70 mL/d of a nutritionally balanced rodent liquid formula (F1268SP, BioServ, Frenchtown, NJ, USA) at a caloric density of 1.0 kcal/mL”
In experiment 1, control group receives solid diet identical to liquid diet in composition (AIN-76) while receiving DDAVP infusion
Note: Control group still receives DDAVP to isolate diet effects
“In experiment 1, the control group received a solid diet identical to the liquid diet in composition (AIN-76) and were infused with DDAVP”
Administer biweekly intramuscular injections of 50,000 U/kg vitamin D3 (GeroVitamins, Zalmoxian Products) to designated groups
Note: Rats in one of the hyponatremic groups and rats on solid AIN-76 diet in experiment 2 received this supplementation
“biweekly intramuscular injections of 50,000 U/kg vitamin D 3 (GeroVitamins, Zalmoxian Products, London, UK)”
Measure and record body weight of all rats biweekly throughout the 3-month experiment
Note: Measurements taken every 2 weeks
“Body weight was measured biweekly”
Replace osmotic minipumps monthly to maintain constant desmopressin levels
Note: Critical for maintaining consistent DDAVP infusion
“The osmotic minipumps were replaced monthly to maintain constant desmopressin levels”
Monitor serum or plasma sodium levels monthly to verify hyponatremia induction and stability
Note: Sodium levels remained stable over the duration of the 3 month experiments
“Serum or plasma sodium levels were monitored monthly and remained stable over the duration of the 3 month experiments”
House rats intermittently in metabolic cages (No. 650-0100, Nalgene) for 24-hour urine collections at the end of each month, both with and without preservative
Note: Collections performed both with and without preservative
“Rats were housed intermittently in metabolic cages (No. 650-0100, Nalgene) for 24 hour urine collections”
Collect 2 mL survival blood by tail vein venipuncture under inhalation anesthesia with isoflurane (3% in oxygen at 0.5 L/min)
Note: Performed at end of 3-month experiment
“Survival blood (2 mL) was collected by tail vein venipuncture under inhalation anesthesia with isoflurane (3% in oxygen at 0.5 L/min)”
Collect nonsurvival blood by cardiac puncture under isoflurane anesthesia. After blood collection, increase isoflurane dose until lack of heart contraction and respiration indicates death.
Note: Terminal procedure performed at end of experiment
“Nonsurvival blood was collected by cardiac puncture, also under isoflurane anesthesia; after blood collection, isoflurane dose was increased until the lack of heart contraction and respiration indicated death”
albino Sprague-Dawley rats obtained from Taconic Farms
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