For some time, it has been known that individuals with a genetic defect in homocysteine metabolism (homocystinuria) have an increased risk of early onset osteoporosis. However, only recently has attention focused on the potential impact of circulating homocysteine concentrations on bone health among the general population. This interest is based on studies that have reported significant relationships between serum homocysteine concentrations and increased risk of fracture in adults. The strength of the relationship observed is substantial and is similar to the relationship found between serum homocysteine concentrations and cardiovascular disease. The mechanisms responsible for the impact of homocysteine concentrations on fracture risk are not known. Increased homocysteine concentrations could possibly interfere with normal collagen production, but studies have not found a significant relationship between serum homocysteine concentrations and bone mineral density, and the impact of elevated homocysteine concentrations on bone health may be indirect. Further research will assist in identifying the mechanisms and relationships between homocysteine and bone health and the degree to which this relationship is influenced by folate, vitamin B12, and vitamin B6 status. Because of the other known adverse consequences of elevated serum homocysteine concentrations, additional incentive to monitor and promote reductions in this amino acid in relation to bone health is warranted.

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