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

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. © The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.