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Fragility fractures and reversible osteopaenia due to chronic hyponatraemia in an adolescent male
  1. Mital Patel1,
  2. Juan Carlos Ayus2,3 and
  3. Michael L Moritz1,4
  1. 1 Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 Medicine, Renal Consultants of Houston, Houston, Texas, USA
  3. 3 Medicine, Irvine School of Medicine, University of California, Irvine, California, USA
  4. 4 Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Michael L Moritz, michael.moritz{at}


Fragility fractures are common in older adults and rare in children. Recent studies have demonstrated that hyponatraemia is a novel risk factor for the development of osteoporosis and hip fractures in older people. Animal studies suggest that hyponatraemia can lead to decreased bone mineral density by stimulating osteoclastic activity in order to mobilise sodium from the bone. Reported is a 16-year-old man with intractable epilepsy and an 11-year history of chronic hyponatraemia (126–135 mEq/L) due to valproic acid induced syndrome of inappropriate antidiuresis who sustained low-impact fragility fractures and had evidence of osteopaenia on both X-ray and dual energy X-ray absorptiometry (DEXA). Hyponatraemia resolved following the discontinuation of valproic acid and bone mineral density normalised on a repeat DEXA 19 months later. This case provides evidence supporting the contention that chronic hyponatraemia contributes to osteopaenia and fragility fractures and that the bone abnormalities are potentially reversible following the correction of hyponatraemia.

  • neurology (drugs and medicines)
  • calcium and bone
  • orthopaedics
  • fluid electrolyte and acid-base disturbances
  • osteoporosis

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  • Contributors MP performed data collection and interpretation, drafted the initial manuscript and reviewed and revised the manuscript. JCA critically reviewed and edited the manuscript. MLM treated the patient, conceptualised the work, critically reviewed and edited the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.