Today’s NEJM released studies from the Netherlands and from the Framingham Study concluding that elevated homocysteine levels being a predictive risk factor for osteoporosis.

Here are comments from the accompanying editorial:

Whether it is a culprit or a bystander, homocysteine can now be added to the growing list of risk factors for fractures. Its use might increase the predictive power of an assessment based not just on bone mineral density, but on multiple risk factors. Such an assessment is sorely needed to provide realistic individualized estimates of the risk of fracture that can guide physicians and patients in planning prevention and treatment.

Homocysteine can be lowered by vitamin supplements such as folic acid, cobalamin (vitamin B12) and pyridoxine (vitamin B6). Discussion about whether these supplements should be added to the current spectrum of osteoporosis treatment would be the next step to consider.