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.
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).
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).
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.
= arginine vasopressin;
= confidence interval;
= chronic kidney disease;
= odds ratio;
= syndrome of inappropriate antidiuretic hormone.
Oral Cancer Carole Fakhry, Karen T. Pitman, Ana P. Kiess
2020
eBook
A state-of-the-art guide on oral cancer management from distinguished experts! Oral Cancer: Evaluation, Therapy, and Rehabilitation edited by prominent Johns Hopkins clinicians and educators Carole ...Fakhry, Karen Pitman, Ana Kiess, and David Eisele provides a comprehensive, state-of-the-art review on the diagnosis and management of oral cancer. This unique resource fills a void in the literature by exploring surgical and reconstructive issues specific to each subsite of the oral cavity. Important pre- and post-treatment evaluations by dental, speech language pathology, and the oncologic care team are reviewed. The comprehensive book is divided into 10 sections, each focused on different facets of the patients' trajectory. The text starts with epidemiology of oral cavity cancer and discussion of patient populations at increased risk of oral cavity cancer. The book details pre-cancers, multidisciplinary diagnostic evaluations, treatment, post-treatment, recurrent and metastatic oral cancer, and palliative care, concluding with future directions such as chemoprevention. A full spectrum of oral neoplasms are covered in depth, including different types of squamous cell cancer, primary malignancies of the mandible, and sublingual and minor salivary gland malignancies. Key Features * All oral cavity subsites are approached from both an ablative and reconstructive standpoint, with dedicated chapters focused on specific oral cancer reconstructive techniques * Discussion of oncologic considerations encompassing radiation and medical oncology including definitive radiation therapy, brachytherapy, adjuvant radiation therapy, and adjuvant chemotherapy/novel therapeutics * Clinical pearls cover complications of both surgery and radiation therapy, as well as psychological and dental implications of therapy * High-quality illustrations, photographs, and videos further elucidate impacted anatomy and techniques Residents and clinicians in otolaryngology-head and neck surgery, oral and maxillofacial surgery, head and neck reconstructive surgery, medical oncology, and radiation oncology will benefit from reading this excellent resource. Dentists who wish to further their knowledge about oral cancers will also find it an invaluable reference.
