The association between homocysteine (hcy) and serum natural antioxidants in elderly bone mineral densitometry (BMD) Mehmet Emin Kuyumcu a, *, Yusuf Yesil a , Zeynel Abidin Oztu ¨ rk b , Esat Cınar c , Cemal Kızılarslanoglu c , Meltem Halil a , Zekeriya Ulger a , Nesibe Karahan Yesil d , Mustafa Cankurtaran a , Servet Arıog ˘ul a a Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Sihhiye, 06100 Ankara, Turkey b Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Sahinbey, 27100 Gaziantep, Turkey c Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey d Numune Training and Research Hospital, Department of Rheumatology, Ankara, Turkey 1. Introduction Osteoporosis is a complex, multifactorial and major public health problem characterized by reduced bone mass and impaired microarchitectural structure with increasing fragility which predisposes the bone to fractures. As the population gets older morbidity, mortality and financial cost related to osteoporosis are expected to rise (Compston, Papapoulos, & Blanchard, 1998; Gabriel et al., 2002). After the acquisition of peak bone mass during the third decade of life, there is a progressive decline of approximately 0.5% a year, which is considered a physiological age related change (Tenenhouse et al., 2000). Advancing age, female gender, early menopause, low body weight, cigarette smoking, low calcium intake, alcohol consumption, a low physical activity level, tallness, prior low-trauma fracture, history of hip fracture in a first degree relative are depicted in previous studies as important risk factors for osteoporosis (Eisman, Clapham, Kehoe, & Study, 2004; Hodgson et al., 2003; Kanis et al., 2002). Bone is a dynamic tissue and subject to a continuous formation and resorption process (Raisz, 2005). During this process osteoclasts remove old bone and then osteoblasts move in and fill this pit with new bone (Mueller & Russell, 2003). Multiple factors including hormones (e.g., estrogens, parathyroid hor- mone, vitamin D), interleukins (e.g., IL-1, IL-6, IL-11), other cytokines (tumor necrosis factor alpha) and growth factors (bone morpho-genetic proteins), regulate bone remodeling (Troen, 2003). Recent in vitro studies or animal models showed oxidative stress had an important impact on osteoclastic and osteoblastic functions (Bai et al., 2004; Lean et al., 2003; Lean, Jagger, Kirstein, Fuller, & Chambers, 2005). This oxidative stress or low circulating levels of antioxidants are supposed to reduce BMD and cause osteoporosis. Archives of Gerontology and Geriatrics 55 (2012) 739–743 A R T I C L E I N F O Article history: Received 17 April 2012 Received in revised form 11 May 2012 Accepted 12 May 2012 Available online 7 June 2012 Keywords: Osteoporosis Oxidative stress Elderly Antioxidant hcy Uric acid A B S T R A C T Previous studies showed oxidative stress had an important impact on osteoclastic and osteoblastic functions. Oxidative stress or low levels of antioxidants are supposed to reduce BMD and cause osteoporosis. hcy, gamma glutamyltransferase (GGT), uric acid, albumin and total bilirubin are simple laboratory parameters that are related with oxidative stress. In this study we compare the serum hcy and antioxidant levels in patients with osteoporosis, osteopenia and control subjects. A total of 2190 elderly persons (1348 patients with osteoporosis, 643 patients with osteopenia and 199 control subjects) who were referred to the outpatient clinic of the Department of Internal Medicine, Division of Geriatric Medicine at Hacettepe University Hospital for comprehensive geriatric assessment were included in this cross-sectional study. Mean age of subjects were 72.30  6.34 in osteoporosis group, 71.92  6.90 in osteopenia and 71.86  5.88 in control group (p: 0.260). Multivariate regression analysis revealed that hypertension (HT) (OR: 0.675, 95% CI: 0.534–0.854, p: 0.001), diabetes mellitus (DM) (OR: 1.669, 95% CI: 1.301–2.142, p: <0.001), age (OR: 1.025, 95% CI: 1.006–1.044, p: 0.009), male gender (OR: 0.451, 95% CI: 0.358–0.569, p < 0.001), uric acid (OR: 0.893, 95% CI: 0.837–0.952, p: 0.001), hcy (OR: 1.042, 95% CI: 1.023– 1.061, p < 0.001), albumin (OR: 0.521, 95% CI: 0.376–0.724, p < 0.001), GGT (OR: 1.010, 95% CI: 1.003–1.017, p: 0.003), creatinine (OR: 0.630, 95% CI: 0.459–0.864, p: 0.004) were independent variables predicting the occurrence of osteoporosis. This study shows there is an imbalance between natural antioxidative and oxidative markers in patients with osteoporosis. Higher serum uric acid and albumin levels are associated with a lower prevalence of osteoporosis whereas higher hcy and GGT levels are associated lower BMD and higher osteoporosis prevalence. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +90 312 305 15 38; fax: +90 312 309 76 20. E-mail address: mekuyumcu@gmail.com (M.E. Kuyumcu). Contents lists available at SciVerse ScienceDirect Archives of Gerontology and Geriatrics jo ur n al ho mep ag e: www .elsevier .c om /lo cate/ar c hg er 0167-4943/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.archger.2012.05.004