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Homocysteine as a predictive factor for hip fracture in older persons.

Abstract

BACKGROUND

The increased prevalence of osteoporosis among people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of osteoporotic fracture. We examined the association between the total homocysteine concentration and the risk of hip fracture in men and women enrolled in the Framingham Study.

METHODS

We studied 825 men and 1174 women, ranging in age from 59 to 91 years, from whom blood samples had been obtained between 1979 and 1982 to measure plasma total homocysteine. The participants in our study were followed from the time that the sample was obtained through June 1998 for incident hip fracture. Sex-specific, age-adjusted incidence rates of hip fracture were calculated for quartiles of total homocysteine concentrations. Cox proportional-hazards regression was used to calculate hazard ratios for quartiles of homocysteine values.

RESULTS

The mean (+/-SD) plasma total homocysteine concentration was 13.4+/-9.1 micromol per liter in men and 12.1+/-5.3 micromol per liter in women. The median duration of follow-up was 12.3 years for men and 15.0 years for women. There were 41 hip fractures among men and 146 among women. The age-adjusted incidence rates per 1000 person-years for hip fracture, from the lowest to the highest quartile for total homocysteine, were 1.96 (95 percent confidence interval, 0.52 to 3.41), 3.24 (0.97 to 5.52), 4.43 (1.80 to 7.07), and 8.14 (4.20 to 12.08) for men and 9.42 (5.72 to 13.12), 7.01 (4.29 to 9.72), 9.58 (6.42 to 12.74), and 16.57 (11.84 to 21.30) for women. Men and women in the highest quartile had a greater risk of hip fracture than those in the lowest quartile--the risk was almost four times as high for men and 1.9 times as high for women.

CONCLUSIONS

These findings suggest that the homocysteine concentration, which is easily modifiable by means of dietary intervention, is an important risk factor for hip fracture in older persons.

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  • Authors+Show Affiliations

    ,

    Hebrew Rehabilitation Center for Aged Research and Training Institute, Boston, USA. rmclean@mail.hrca.harvard.edu

    , , , , , , ,

    Source

    The New England journal of medicine 350:20 2004 May 13 pg 2042-9

    MeSH

    Aged
    Aged, 80 and over
    Female
    Follow-Up Studies
    Hip Fractures
    Homocysteine
    Humans
    Hyperhomocysteinemia
    Incidence
    Male
    Middle Aged
    Osteoporosis
    Proportional Hazards Models
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15141042

    Citation

    McLean, Robert R., et al. "Homocysteine as a Predictive Factor for Hip Fracture in Older Persons." The New England Journal of Medicine, vol. 350, no. 20, 2004, pp. 2042-9.
    McLean RR, Jacques PF, Selhub J, et al. Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med. 2004;350(20):2042-9.
    McLean, R. R., Jacques, P. F., Selhub, J., Tucker, K. L., Samelson, E. J., Broe, K. E., ... Kiel, D. P. (2004). Homocysteine as a predictive factor for hip fracture in older persons. The New England Journal of Medicine, 350(20), pp. 2042-9.
    McLean RR, et al. Homocysteine as a Predictive Factor for Hip Fracture in Older Persons. N Engl J Med. 2004 May 13;350(20):2042-9. PubMed PMID: 15141042.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Homocysteine as a predictive factor for hip fracture in older persons. AU - McLean,Robert R, AU - Jacques,Paul F, AU - Selhub,Jacob, AU - Tucker,Katherine L, AU - Samelson,Elizabeth J, AU - Broe,Kerry E, AU - Hannan,Marian T, AU - Cupples,L Adrienne, AU - Kiel,Douglas P, PY - 2004/5/14/pubmed PY - 2004/5/18/medline PY - 2004/5/14/entrez SP - 2042 EP - 9 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 350 IS - 20 N2 - BACKGROUND: The increased prevalence of osteoporosis among people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of osteoporotic fracture. We examined the association between the total homocysteine concentration and the risk of hip fracture in men and women enrolled in the Framingham Study. METHODS: We studied 825 men and 1174 women, ranging in age from 59 to 91 years, from whom blood samples had been obtained between 1979 and 1982 to measure plasma total homocysteine. The participants in our study were followed from the time that the sample was obtained through June 1998 for incident hip fracture. Sex-specific, age-adjusted incidence rates of hip fracture were calculated for quartiles of total homocysteine concentrations. Cox proportional-hazards regression was used to calculate hazard ratios for quartiles of homocysteine values. RESULTS: The mean (+/-SD) plasma total homocysteine concentration was 13.4+/-9.1 micromol per liter in men and 12.1+/-5.3 micromol per liter in women. The median duration of follow-up was 12.3 years for men and 15.0 years for women. There were 41 hip fractures among men and 146 among women. The age-adjusted incidence rates per 1000 person-years for hip fracture, from the lowest to the highest quartile for total homocysteine, were 1.96 (95 percent confidence interval, 0.52 to 3.41), 3.24 (0.97 to 5.52), 4.43 (1.80 to 7.07), and 8.14 (4.20 to 12.08) for men and 9.42 (5.72 to 13.12), 7.01 (4.29 to 9.72), 9.58 (6.42 to 12.74), and 16.57 (11.84 to 21.30) for women. Men and women in the highest quartile had a greater risk of hip fracture than those in the lowest quartile--the risk was almost four times as high for men and 1.9 times as high for women. CONCLUSIONS: These findings suggest that the homocysteine concentration, which is easily modifiable by means of dietary intervention, is an important risk factor for hip fracture in older persons. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/15141042/Homocysteine_as_a_predictive_factor_for_hip_fracture_in_older_persons_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa032739?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -