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QJM Advance Access published online on June 27, 2005
QJM, doi:10.1093/qjmed/hci092
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received February 8, 2005
Revised May 17, 2005

Original paper

Hyperhomocysteinaemia and aortic calcification are associated with fractures in patients on haemodialysis

S.A. Jamal 1*, R.E. Leiter 1, and D.C. Bauer 2

1 From the Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Canada
2 From the Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, USA

* To whom correspondence should be addressed.
S.A. Jamal, E-mail: sophie.jamal{at}utoronto.ca


  Abstract

Background: Fractures and atherosclerosis are common in patients with renal failure; this may be due to hyperhomocysteinemia.

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

Design: 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).

Discussion: Hyperhomocysteinaemia may explain the relationship between fractures and atherosclerosis in patients with renal failure.


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A. M. Sawka, J. G. Ray, Q. Yi, R. G. Josse, and E. Lonn
Randomized Clinical Trial of Homocysteine Level Lowering Therapy and Fractures
Arch Intern Med, October 22, 2007; 167(19): 2136 - 2139.
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