Hyperhomocysteinaemia and aortic calcification are associated with fractures in patients on haemodialysis.
BACKGROUND
Fractures and atherosclerosis are common in patients with renal failure; this may be due to hyperhomocysteinemia.


OBJECTIVE
To examine the relationships between fractures, vascular calcification and homocysteine levels in haemodialysis patients.


METHODS
Cross-sectional survey.


METHODS
We enrolled 37 men and 15 women who had been on haemodialysis for at least 1 year. We identified prevalent spine fractures by radiographs. Non-spine fractures were identified by self-report and confirmed by review of radiographs or radiology reports. We classified the presence and severity of lumbar aortic calcifications with lateral lumbar radiographs. We measured serum homocysteine in all subjects within 30 days of study entry.


RESULTS
After adjusting for age and weight, increased levels of homocysteine were associated with an increased risk fracture (OR per mmol/l increase in homocysteine 1.6, 95%CI 1.2-2.0), as was the presence of aortic calcification (OR 1.6, 95%CI 1.2-2.1). Homocysteine and lumbar aortic calcification were highly correlated (r = 0.86).


CONCLUSIONS
Hyperhomocysteinaemia may explain the relationship between fractures and atherosclerosis in patients with renal failure.
Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Canada. sophie.jamal@utoronto.ca
S A
SA
Jamal
R E
RE
Leiter
D C
DC
Bauer
D000368:Aged; D002114:Calcinosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016103:Spinal Fractures / Q000209:etiology; D014652:Vascular Diseases / Q000209:etiology*
D006710:Homocysteine