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. 2025 Jan 6;17(1):192.
doi: 10.3390/nu17010192.

Associations of Serum Homocysteine with Bone Mineral Density and Osteoporosis Incidence in Chinese Middle-Aged and Older Adults: A Retrospective Cohort Study

Jiupeng Zou  1 , Mi Shu  2 , Jiedong Chen  1 , Maierhaba Wusiman  1 , Jialu Ye  1 , Sishi Yang  2 , Si Chen  1 , Zihui Huang  1 , Bixia Huang  1 , Aiping Fang  1 , Huilian Zhu  1
Affiliations

Associations of Serum Homocysteine with Bone Mineral Density and Osteoporosis Incidence in Chinese Middle-Aged and Older Adults: A Retrospective Cohort Study

Jiupeng Zou et al. Nutrients. .

Abstract

Objective: This research investigated the prospective association of serum homocysteine with lumbar bone mineral density (BMD) and the risk of osteoporosis in the Chinese population.

Methods: In this cohort, 2551 Chinese individuals aged ≥50 years underwent annual health examinations. Among them, 2551, 1549, and 926 completed two, three, and more than three examinations, respectively. We used generalized estimating equations to analyze the connection between serum homocysteine and lumbar BMD. Additionally, we assessed the connection between serum homocysteine and the incidence of osteoporosis using Cox proportional hazard models. Subgroup analyses based on covariates were performed to identify important at-risk populations.

Results: Participants with higher homocysteine levels showed decreased lumbar BMD compared to those with lower homocysteine levels (p-trend < 0.05). Specifically, lumbar BMD decreased by -0.002 (-0.003, -0.001) g/cm2 for every standard deviation increase in log-transformed serum homocysteine. Compared to the lowest quartile of homocysteine levels, lumbar BMD decreased by -0.006 (-0.010, -0.002) g/cm2 in the highest quartile in men. In smokers, lumbar BMD decreased by -0.007 (-0.012, -0.003) g/cm2 in the highest quartile. During the follow-up period, 175 incidences of osteoporosis were recorded. Serum homocysteine was linked to an increased risk of osteoporosis (p-trend < 0.05). Furthermore, for every standard deviation rise in log-transformed homocysteine, the HR for osteoporosis was 1.33 (95% CI, 1.12-1.58).

Conclusions: Elevated homocysteine levels may be responsible for reduced lumbar BMD in middle-aged and older Chinese people, especially men and smokers. In addition, elevated homocysteine levels may be a risk factor for the development of osteoporosis.

Keywords: bone mineral density; homocysteine; osteoporosis; risk factor.

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Conflict of interest statement

Authors Mi Shu and Sishi Yang were affiliated with the Yibicom Health Management Center. The other authors state that this research was carried out without any commercial or financial associations that could be perceived as potential conflicts of interest.

Figures

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Figure 1
Flowchart of study participants.
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