Gerdhem Paul, Ivaska Kaisa K, Isaksson Anders, Pettersson Kim, Väänänen H Kalervo, Obrant Karl J, Akesson Kristina
Department of Orthopaedics, Malmö University Hospital, Sweden.
J Bone Miner Res. 2007 Jan;22(1):127-34. doi: 10.1359/jbmr.061003.
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.
Recently, the association between high serum homocysteine (Hcy) levels and an increased risk of fracture has been described.
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.
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.
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.
同型半胱氨酸被认为是骨折的一个风险因素，但因果关系尚不清楚。在OPRA研究的996名女性中，高同型半胱氨酸水平与基线时高骨标志物水平和低骨密度相关。在平均7年的随访期间，高同型半胱氨酸水平与死亡率相关，但与骨折风险无明显关联。
最近，血清高同型半胱氨酸（Hcy）水平升高与骨折风险增加之间的关联已被描述。
测量了996名75岁女性的基线Hcy水平。在基线时评估了维生素B12、叶酸、血清I型胶原交联端肽（CTX）、血清抗酒石酸酸性磷酸酶5b（TRACP5b）、血清骨钙素、尿脱氧吡啶啉、甲状旁腺激素（PTH）、面积骨密度（aBMD）、跟骨定量超声（QUS）和身体机能。在平均7.0年的随访期间记录骨折和死亡率。
与所有其他女性相比，Hcy处于最高四分位数的女性骨标志物水平更高（p<0.05）。Hcy与骨标志物之间最明显的相关性见于CTX（r = 0.19，p<0.001）。与其他女性相比，Hcy处于最高四分位数的女性的aBMD（髋部）低4%，QUS低达2%，步态速度慢11%（p<0.05）。在随访期间，267名女性发生了至少一次低能量骨折（包括69例髋部骨折）。当将Hcy处于最高四分位数的女性与所有其他女性进行比较时，发生任何类型骨折的风险比（HR）为1.18（95%CI，0.89 - 1.36），髋部骨折的HR为1.50（95%CI，0.91 - 1.94）。对于同一组女性，死亡风险为2.16（95%CI，1.58 - 2.55）。对混杂因素进行调整并没有实质性改变这些关联。对PTH进行调整后，髋部骨折的HR增加到1.67（95%CI，1.01 - 2.17）。低维生素B12或叶酸与骨折风险增加或死亡率无关。
高Hcy水平与较高的骨转换、较差的身体机能和较低的骨密度相关。与骨折风险无明显关联。Hcy水平高的女性死亡率增加表明高Hcy水平可能是虚弱的一个标志物。
