Homocysteine as a predictive factor for hip fracture in older persons
Homocysteine as a predictive factor for hip fracture in older persons
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DOI：
10.1056/nejmoa032739
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发表时间：
2004-05-13
影响因子：
158.5
通讯作者：
Kiel, DP
中科院分区：
文献类型：
--
作者：
McLean, RR;Jacques, PF;Kiel, DP
背景：同型半胱氨酸尿症患者中骨质疏松症患病率的增加表明高血清同型半胱氨酸浓度可能通过干扰胶原交联而削弱骨，从而增加骨质疏松性骨折的风险。我们研究了总同型半胱氨酸浓度和髋部骨折的风险之间的关联，男性和女性参加了Fraidian Study.METHODS：我们研究了825名男性和1174名女性，年龄范围从59至91岁，从1979年和1982年之间获得的血液样本，以测量血浆总同型半胱氨酸。我们研究的参与者从获得样本到1998年6月因髋部骨折事件接受了随访。根据总同型半胱氨酸浓度的四分位数计算性别、年龄校正的髋部骨折发病率。考克斯比例风险回归用于计算同型半胱氨酸值的四分位数的风险比。结果：平均（+/-SD）血浆总同型半胱氨酸浓度为13.4+/-9.1微摩尔每升的男性和12.1+/-5.3微摩尔每升的女性。男性的中位随访时间为12.3年，女性为15.0年。男性中有41例髋部骨折，女性中有146例。髋部骨折的年龄校正发病率每1000人-年，总同型半胱氨酸从最低到最高的四分位数为1.96（95%置信区间，0.52至3.41），3.24（0.97至5.52）、4.43（1.80至7.07）和8.14（4.20至12.08）男性和9.42（5.72至13.12），7.01（4.29至9.72），9.58（6.42至12.74）和16.57（11.84至21.30）女性。男性和女性在最高的四分位数有一个更大的风险髋部骨折比那些在最低的四分位数的风险几乎是男性的4倍，1.9倍，为女性的高CONCLUSIONS：这些研究结果表明，同型半胱氨酸的浓度，这是很容易修改的饮食干预手段，是一个重要的危险因素髋部骨折的老年人。
BACKGROUND:The increased prevalence of osteoporosis among people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of osteoporotic fracture. We examined the association between the total homocysteine concentration and the risk of hip fracture in men and women enrolled in the Framingham Study.METHODS:We studied 825 men and 1174 women, ranging in age from 59 to 91 years, from whom blood samples had been obtained between 1979 and 1982 to measure plasma total homocysteine. The participants in our study were followed from the time that the sample was obtained through June 1998 for incident hip fracture. Sex-specific, age-adjusted incidence rates of hip fracture were calculated for quartiles of total homocysteine concentrations. Cox proportional-hazards regression was used to calculate hazard ratios for quartiles of homocysteine values.RESULTS:The mean (+/-SD) plasma total homocysteine concentration was 13.4+/-9.1 micromol per liter in men and 12.1+/-5.3 micromol per liter in women. The median duration of follow-up was 12.3 years for men and 15.0 years for women. There were 41 hip fractures among men and 146 among women. The age-adjusted incidence rates per 1000 person-years for hip fracture, from the lowest to the highest quartile for total homocysteine, were 1.96 (95 percent confidence interval, 0.52 to 3.41), 3.24 (0.97 to 5.52), 4.43 (1.80 to 7.07), and 8.14 (4.20 to 12.08) for men and 9.42 (5.72 to 13.12), 7.01 (4.29 to 9.72), 9.58 (6.42 to 12.74), and 16.57 (11.84 to 21.30) for women. Men and women in the highest quartile had a greater risk of hip fracture than those in the lowest quartile - the risk was almost four times as high for men and 1.9 times as high for women.CONCLUSIONS:These findings suggest that the homocysteine concentration, which is easily modifiable by means of dietary intervention, is an important risk factor for hip fracture in older persons.