Homocysteine Levels and the Risk of Osteoporotic Fracture

Patients with homocystinuria, a rare autosomal recessive disease characterized by very high plasma homocysteine levels, frequently have osteoporosis and fractures — an observation that led the authors to examine the association between homocysteine levels and osteoporotic fracture in the context of normal aging. The multivariable-adjusted relative risk of incident osteoporotic fracture was 1.4 (95 percent confidence interval, 1.2 to 1.7) for each increase of 1 SD in the natural-log–transformed homocysteine level. Data on the risk of osteoporotic fracture among 2406 persons in two separate prospective studies of aging. Osteoporosis is a major health problem that is characterized by low bone mineral density, deterioration of bone microarchitecture, and an increased risk of fracture. 1 Osteoporotic fractures are associated with increased morbidity and mortality and with substantial economic costs. 2 – 4 It has been hypothesized that the metabolism of homocysteine is involved in osteoporosis. Homocystinuria, a rare autosomal recessive disease characterized by markedly elevated levels of plasma homocysteine, has several clinical manifestations involving the eyes, the vasculature, and the central nervous system. The presence of homocystinuria is associated with the early onset of generalized osteoporosis. 5 , 6 The underlying pathophysiological mechanism for the . . .