Homocysteine and Fracture Prevention

摘要

A wide spectrum of diseases is already associated with elevated circulating homocysteine concentrations, such as cardiovascular disease (including stroke) and cognitive impairment.6'7 Because these diseases are also associated with a high fracture risk, they could be confounding factors. However, Sato et al adjusted their risk estimates for cardiovascular events and presence of dementia without an effect on the study outcome. More important, the fall frequency was similar in both groups, which means that with the same number of falls, the placebo group fractured more easily. Because the recording of the falls was well-validated with a "fall calendar" in combination with a monthly visit to the clinic, cognitive impairment without dementia, which could affect recall of the falls, is an unlikely confounder. Nevertheless, similar intervention studies in patients other than those who have had a stroke will be necessary to show generalizabil-ity of the conclusions.