title: Folate, but not homocysteine, predicts the risk of fracture in elderly persons.
abstract: BACKGROUND
  Recent prospective studies reported that increased plasma homocysteine levels are an independent predictor of osteoporotic fracture in elderly persons. These studies, however, did not take into account folate and vitamin B12, which are the major nutritional determinants of homocysteinemia.
  
  
  METHODS
  Incident osteoporotic fractures were assessed in 702 Italian participants aged 65-94 years with a mean follow-up of 4 years (1999/2000-2003/2004). A multivariable logistic regression model was used to study the relation of baseline plasma homocysteine, serum folate, and serum vitamin B12 with risk of fracture.
  
  
  RESULTS
  After adjustment for sociodemographic and clinical confounders, the odds ratio (OR) for each increase of 1 standard deviation in log-transformed plasma homocysteine was 1.39 (95% confidence interval [CI], 1.01-1.91), but decreased to 1.22 (95% CI, 0.85-1.74) after further adjustment for serum folate and vitamin B12. The corresponding multivariable-adjusted OR for hyperhomocysteinemia (plasma total homocysteine [tHcy] > 15 micromoL) was 1.58 (95% CI, 0.71-3.53). Participants in the lowest serum folate quartile (< or =9.3 nmol/L) had an increased risk of fracture than did those in higher quartiles (multivariable-adjusted OR = 2.06; 95% CI. 1.02-4.18), but no dose-related protective effect for increasing serum folate levels was found (multivariable-adjusted OR = 0.84 for each increase of 1 standard deviation in log-transformed serum folate, 95% CI, 0.59-1.19). No independent association was found for serum vitamin B12.
  
  
  CONCLUSIONS
  Low serum folate is responsible for the association between homocysteine and risk of osteoporotic fracture in elderly persons.
authors.affiliation: Department of Internal Medicine, Cardioangiology, and Hepatology-University Hospital S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. ravaglia@med.unibo.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ravaglia
authors.forename: Paola
authors.initials: P
authors.lastname: Forti
authors.forename: Fabiola
authors.initials: F
authors.lastname: Maioli
authors.forename: Lucia
authors.initials: L
authors.lastname: Servadei
authors.forename: Mabel
authors.initials: M
authors.lastname: Martelli
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Brunetti
authors.forename: Luciana
authors.initials: L
authors.lastname: Bastagli
authors.forename: Domenico
authors.initials: D
authors.lastname: Cucinotta
authors.forename: Erminia
authors.initials: E
authors.lastname: Mariani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001851:Bone Diseases, Metabolic / Q000150:complications; D002851:Chromatography, High Pressure Liquid; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005492:Folic Acid / Q000097:blood*; D050723:Fractures, Bone / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D006710:Homocysteine; D005492:Folic Acid