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Am J Clin Nutr. 2015 Sep;102(3):687-94. doi: 10.3945/ajcn.115.108787. Epub 2015 Jul 29.

B-vitamin status and bone mineral density and risk of lumbar osteoporosis in older females in the United States.

Author information

1
Office of Dietary Supplements and Department of Nutrition Science, Purdue University, West Lafayette, IN; and baileyr@mail.nih.gov.
2
National Center for Health Statistics, CDC, Hyattsville, MD;
3
Eunice Kennedy Shriver National Institute of Child and Human Development, NIH, Bethesda, MD;
4
Department of Nutrition Science, Purdue University, West Lafayette, IN; and.
5
ICF International, Rockville, MD.

Abstract

BACKGROUND:

Previous data suggest that elevated serum total homocysteine (tHcy) may be a risk factor for bone fracture and osteoporosis. Nutritional causes of elevated tHcy are suboptimal B-vitamin status. To our knowledge, this is the first nationally representative report on the relation of B vitamins and bone health from a population with folic acid fortification.

OBJECTIVE:

The purpose of this analysis was to examine the relation between B-vitamin status biomarkers and bone mineral density (BMD), risk of osteoporosis, and biomarkers of bone turnover.

DESIGN:

We examined the relation of tHcy, methylmalonic acid (MMA), and serum/red blood cell folate and total-body and lumbar spine BMD in women aged ≥50 y participating in the NHANES 1999-2004 (n = 2806), a nationally representative cross-sectional survey. These are the only years with concurrent measurement of tHcy and whole-body dual-energy X-ray absorptiometry. We also examined B-vitamin biomarkers relative to bone turnover markers, bone alkaline phosphatase, and urinary N-terminal cross-linked telopeptide of type I collagen in a 1999-2002 subset with available data (n = 1813).

RESULTS:

In comparison with optimal concentrations, women with elevated tHcy were older with lower serum vitamin B-12, red blood cell folate, and dietary micronutrient intakes and had significantly higher mean ± SE markers of bone turnover (bone alkaline phosphatase: 15.8 ± 0.59 compared with 14.0 ± 0.25 μg/L; urinary N-terminal cross-linked telopeptide of type I collagen: 48.2 ± 2.9 compared with 38.9 ± 0.90 nmol bone collagen equivalents per mmol creatinine/L). Elevated MMA (OR: 1.88; 95% CI: 1.10, 3.18) and tHcy (OR: 2.17; 95% CI: 1.14, 4.15) were related to increased risk of lumbar osteoporosis. When examined as a continuous variable, tHcy was negatively associated, serum folates were positively associated, and MMA and vitamin B-12 were not significantly associated with lumbar and total-body BMD.

CONCLUSION:

In this nationally representative population of older US women with high exposure to B vitamins through food fortification and dietary supplements, only elevated tHcy and MMA were independently associated with risk of lumbar spine osteoporosis.

KEYWORDS:

DXA; NHANES; bone turnover markers; homocysteine; osteoporosis

PMID:
26224297
PMCID:
PMC4548174
DOI:
10.3945/ajcn.115.108787
[Indexed for MEDLINE]
Free PMC Article

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