We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comments, Opinions, and Brief Case Reports |

Randomized Clinical Trial of Homocysteine Level–Lowering Therapy and Fractures

Anna M. Sawka, MD, PhD, FRCPC; Joel G. Ray, MD, MSc, FRCPC; Qilong Yi, PhD; Robert G. Josse, MBBS, FRCP; Eva Lonn, MD, MSc, FRCPC
Arch Intern Med. 2007;167(19):2136-2139. doi:10.1001/archinte.167.19.2136.
Text Size: A A A
Published online


Hyperhomocysteinemia is associated with an increased risk of skeletal fractures.15 For example, in a prospective cohort study of 2406 individuals from the Netherlands, the associated relative risk of fracture was 1.4 per 1-SD increase in plasma homocysteine.1 In a US prospective study of 825 men and 1174 women, the highest quartile of plasma homocysteine concentration was associated with nearly a 4 times higher risk of hip fracture in men and 1.9 times higher risk in women compared with the lowest quartile.3 Little is known about the effect of lowering homocysteine levels on the risk of clinical fractures. We evaluated the effect of combined treatment with folic acid, pyridoxine hydrochloride (also known as vitamin B6), and cyanocobalamin (also known as vitamin B12) on the risk of clinical fractures in a randomized placebo-controlled trial.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

Cumulative probability of skeletal fracture following homocysteine-lowering therapy compared with placebo.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

19 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles