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Associations between homocysteine, bone turnover, BMD, mortality, and fracture risk in elderly women.

Abstract

Homocysteine has been suggested to be a risk factor for fracture, but the causal relationship is not clear. In 996 women from the OPRA study, high homocysteine level was associated with high bone marker levels and low BMD at baseline. During a mean 7-year follow-up, high homocysteine level was associated with mortality, but no clear association to fracture risk existed.

INTRODUCTION

Recently, the association between high serum homocysteine (Hcy) levels and an increased risk of fracture has been described.

MATERIALS AND METHODS

Hcy levels were measured at baseline in 996 women, all 75 years old. Vitamin B(12), folate, serum cross-linking telopeptide of type I collagen (CTX), serum TRACP5b, serum osteocalcin, urine deoxypyridinoline, PTH, areal BMD (aBMD), calcaneal quantitative ultrasound (QUS), and physical performance were assessed at baseline. Fractures and mortality were recorded during a mean follow-up of 7.0 years.

RESULTS

Bone marker levels were higher in women with Hcy in the highest quartile compared with all other women (p < 0.05). The most evident correlation between Hcy and a bone marker was seen with CTX (r = 0.19, p < 0.001). aBMD (hip) was 4% lower, QUS was up to 2% lower, and gait speed was 11% slower among women with Hcy in the highest quartile compared with the other women (p < 0.05). During the follow-up, 267 women sustained at least one low-energy fracture (including 69 hip fractures). When women in the highest Hcy quartile were compared with all other women, the hazard ratios (HRs) for sustaining any type of fracture was 1.18 (95% CI, 0.89-1.36) and for hip fracture was 1.50 (95% CI, 0.91-1.94). For the same group of women, the mortality risk was 2.16 (95% CI, 1.58-2.55). Adjustments for confounders did not substantially change these associations. Adjustment for PTH increased the HR for hip fracture to 1.67 (95% CI, 1.01-2.17). Low vitamin B(12) or folate was not associated with increased fracture risk or mortality.

CONCLUSIONS

High Hcy levels were associated with higher bone turnover, poor physical performance, and lower BMD. There was no clear association to fracture risk. The increased mortality among women with high Hcy levels indicates that a high Hcy level may be a marker of frailty.

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  • Authors+Show Affiliations

    ,

    Department of Orthopaedics, Malmö University Hospital, Sweden. paul.gerdhem@med.lu.se

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    Source

    MeSH

    Aged
    Biomarkers
    Bone Density
    Bone and Bones
    Female
    Follow-Up Studies
    Fractures, Bone
    Homocysteine
    Humans
    Risk Factors
    Surveys and Questionnaires
    Survival Analysis

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17032146

    Citation

    Gerdhem, Paul, et al. "Associations Between Homocysteine, Bone Turnover, BMD, Mortality, and Fracture Risk in Elderly Women." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 22, no. 1, 2007, pp. 127-34.
    Gerdhem P, Ivaska KK, Isaksson A, et al. Associations between homocysteine, bone turnover, BMD, mortality, and fracture risk in elderly women. J Bone Miner Res. 2007;22(1):127-34.
    Gerdhem, P., Ivaska, K. K., Isaksson, A., Pettersson, K., Väänänen, H. K., Obrant, K. J., & Akesson, K. (2007). Associations between homocysteine, bone turnover, BMD, mortality, and fracture risk in elderly women. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 22(1), pp. 127-34.
    Gerdhem P, et al. Associations Between Homocysteine, Bone Turnover, BMD, Mortality, and Fracture Risk in Elderly Women. J Bone Miner Res. 2007;22(1):127-34. PubMed PMID: 17032146.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Associations between homocysteine, bone turnover, BMD, mortality, and fracture risk in elderly women. AU - Gerdhem,Paul, AU - Ivaska,Kaisa K, AU - Isaksson,Anders, AU - Pettersson,Kim, AU - Väänänen,H Kalervo, AU - Obrant,Karl J, AU - Akesson,Kristina, PY - 2006/10/13/pubmed PY - 2007/7/17/medline PY - 2006/10/13/entrez SP - 127 EP - 34 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J. Bone Miner. Res. VL - 22 IS - 1 N2 - UNLABELLED: Homocysteine has been suggested to be a risk factor for fracture, but the causal relationship is not clear. In 996 women from the OPRA study, high homocysteine level was associated with high bone marker levels and low BMD at baseline. During a mean 7-year follow-up, high homocysteine level was associated with mortality, but no clear association to fracture risk existed. INTRODUCTION: Recently, the association between high serum homocysteine (Hcy) levels and an increased risk of fracture has been described. MATERIALS AND METHODS: Hcy levels were measured at baseline in 996 women, all 75 years old. Vitamin B(12), folate, serum cross-linking telopeptide of type I collagen (CTX), serum TRACP5b, serum osteocalcin, urine deoxypyridinoline, PTH, areal BMD (aBMD), calcaneal quantitative ultrasound (QUS), and physical performance were assessed at baseline. Fractures and mortality were recorded during a mean follow-up of 7.0 years. RESULTS: Bone marker levels were higher in women with Hcy in the highest quartile compared with all other women (p < 0.05). The most evident correlation between Hcy and a bone marker was seen with CTX (r = 0.19, p < 0.001). aBMD (hip) was 4% lower, QUS was up to 2% lower, and gait speed was 11% slower among women with Hcy in the highest quartile compared with the other women (p < 0.05). During the follow-up, 267 women sustained at least one low-energy fracture (including 69 hip fractures). When women in the highest Hcy quartile were compared with all other women, the hazard ratios (HRs) for sustaining any type of fracture was 1.18 (95% CI, 0.89-1.36) and for hip fracture was 1.50 (95% CI, 0.91-1.94). For the same group of women, the mortality risk was 2.16 (95% CI, 1.58-2.55). Adjustments for confounders did not substantially change these associations. Adjustment for PTH increased the HR for hip fracture to 1.67 (95% CI, 1.01-2.17). Low vitamin B(12) or folate was not associated with increased fracture risk or mortality. CONCLUSIONS: High Hcy levels were associated with higher bone turnover, poor physical performance, and lower BMD. There was no clear association to fracture risk. The increased mortality among women with high Hcy levels indicates that a high Hcy level may be a marker of frailty. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/17032146/Associations_between_homocysteine_bone_turnover_BMD_mortality_and_fracture_risk_in_elderly_women_ L2 - https://doi.org/10.1359/jbmr.061003 DB - PRIME DP - Unbound Medicine ER -