Coffee consumption and risk of type 2 diabetes mellitus in Asians: A meta-epidemiological study of population-based cohort studies

BACKGROUNDPrevious systematic reviews have consistently reported that coffee consumption has a preventive effect on the occurrence of type 2 diabetes mellitus (T2DM). However, further evaluations between coffee consumption and the risk of T2DM in Asian populations are needed.AIMTo conduct a meta-epidemiological study on systematic reviews evaluating the association between coffee consumption and the risk of T2DM in Asian people. METHODSThe selection criterion was defined as a population-based prospective cohort study evaluating the association between coffee consumption and the risk of T2DM in Asian populations, reporting the adjusted relative risk (RR) and its 95% confidence interval (CI) for potential confounders. A fixed-effect model meta-analysis was applied to calculate the summary RR and its 95%CI in less than 50% of the I² value indicating the level of heterogeneity. A two-stage fixed-effects dose-response meta-analysis (DRMA) was performed to calculate the risk per unit dose (a cup per day). RESULTSA total of seven studies were selected in this meta-epidemiological study. The risk of T2DM in Asian populations was significantly reduced in the highest to the lowest dose group (summary RR = 0.73, 95%CI: 0.66-0.82; I² value = 0.0%). The DRMA showed that drinking one cup of coffee per day reduced the risk of T2DM in Asian populations by 8% (RR = 0.92, 95%CI: 0.90-0.95). CONCLUSIONThese findings support the conclusion that coffee consumption has a protective effect on the occurrence of T2DM in Asian men and women.     

Coffee and caffeine consumption in relation to sex hormone-binding globulin and risk of type 2 diabetes in postmenopausal women

OBJECTIVE

Coffee consumption has been inversely associated with type 2 diabetes risk, but its mechanisms are largely unknown. We aimed to examine whether plasma levels of sex hormones and sex hormone–binding globulin (SHBG) may account for the inverse association between coffee consumption and type 2 diabetes risk.

RESEARCH DESIGN AND METHODS

We conducted a case-control study nested in the prospective Women''s Health Study (WHS). During a median follow-up of 10 years, 359 postmenopausal women with newly diagnosed type 2 diabetes were matched with 359 control subjects by age, race, duration of follow-up, and time of blood draw.

RESULTS

Caffeinated coffee was positively associated with SHBG but not with sex hormones. Multivariable-adjusted geometric mean levels of SHBG were 26.6 nmol/l among women consuming ≥4 cups/day of caffeinated coffee and 23.0 nmol/l among nondrinkers (P for trend = 0.01). In contrast, neither decaffeinated coffee nor tea was associated with SHBG or sex hormones. The multivariable-adjusted odds ratio (OR) of type 2 diabetes for women consuming ≥4 cups/day of caffeinated coffee compared with nondrinkers was 0.47 (95% CI 0.23–0.94; P for trend = 0.047). The association was largely attenuated after further adjusting for SHBG (OR 0.71 [95% CI 0.31–1.61]; P for trend = 0.47). In addition, carriers of rs6259 minor allele and noncarriers of rs6257 minor allele of SHBG gene consuming ≥2 cups/day of caffeinated coffee had lower risk of type 2 diabetes in directions corresponding to their associated SHBG.

CONCLUSIONS

Our findings suggest that SHBG may account for the inverse association between coffee consumption and type 2 diabetes risk among postmenopausal women.Previous prospective studies have documented an inverse association between coffee consumption and type 2 diabetes risk (1,2), especially in women (2). Coffee intake may improve glucose tolerance via activation of energy metabolism and enhancement of insulin sensitivity and β-cell function (2,3)—although much of the molecular mechanism remains unknown. Previous cross-sectional studies have associated coffee intake with plasma levels of sex hormones or sex hormone–binding globulin (SHBG) (4,5). In addition, a large body of observational and experimental data has implicated the important roles of sex hormones in the development of type 2 diabetes (6–8). Notably, recent experiments indicate that SHBG not only regulates the biologically active fraction of sex hormones but may bind to its own receptors at the plasma membranes of a variety of cells, directly mediating intracellular signaling of sex hormones (9). More recently, prospective studies of men and women incorporating both genetic and phenotypic assessment of SHBG revealed a strong inverse association between SHBG levels and type 2 diabetes risk (10). However, no studies have comprehensively evaluated the interrelationships of coffee consumption in relation to sex hormones and SHBG with respect to type 2 diabetes risk. To examine whether and to what extent sex hormones or SHBG may account for the potential protective effect of coffee intake against type 2 diabetes, we analyzed data from a prospective case-control study of women. In particular, we evaluated the associations of coffee consumption with plasma levels of sex hormones and SHBG, as well as the direct association between coffee consumption and type 2 diabetes risk during a 10-year follow-up. Moreover, we investigated whether the association of coffee consumption with type 2 diabetes risk was attenuated by further adjusting for plasma sex hormones or SHBG. Finally, we examined whether coffee intake may interact with specific SHBG genotypes in affecting diabetes risk.     

Exercise distance and speed affect the risk of fracture in racehorses

In order to gain insight into those training regimens that can minimise the risk of fracture in athletic populations, we conducted a large epidemiological study in racehorses. Thoroughbred racehorses provide a suitable model for studying fracture development and exercise-related risk factors in physically active populations. They represent a homogeneous population, undertaking intensive exercise programmes that are sufficiently heterogeneous to determine those factors that influence injury risk. Daily exercise information was recorded for a cohort of 1178 thoroughbreds that were monitored for up to 2 years. A total of 148 exercise-induced fractures occurred in the study population. Results from a nested case–control study showed a strong interactive effect of exercise distances at different speeds on fracture risk. Horses that exceeded 44 km at canter (≤ 14 m/s) and 6 km at gallop (> 14 m/s) in a 30-day period were at particularly increased risk of fracture. These distances equate to ca. 7700 bone loading cycles at canter and 880 loading cycles at gallop. Fifty-six fractures occurred in the subset of study horses that were followed since entering training as yearlings, when skeletally immature (n = 335). Cohort analysis of this data set showed that, in previously untrained bones, accumulation of canter exercise increased the risk of fracture (P ≤ 0.01), whereas accumulation of high-speed gallop exercise had a protective effect (P < 0.01). However, increasing distances at canter and gallop in short time periods (up to one month) were associated with an increasing fracture risk. All training exercise involves a balance between the risk of fracture inherent in exposure to loading and the beneficial effect that loading has by stimulating bone cells to produce a more robust architecture. Results from our study provide important epidemiological evidence of the effects of physical exercise on bone adaptation and injury risk and can be used to inform the design of safer exercise regimens in physically active populations.     

绝经后妇女骨质疏松性骨折易发因素的流行病学研究

目的 探讨绝经后妇女骨质疏松性骨折的分布特征和易发因素。方法 以社区50-69岁绝经1年以上妇女为研究对象,问卷调查危险因素,双能X线骨密度仪测量骨密度(Bone MineralDensity,BMD),胸腰椎侧位X摄片分析椎体骨折,结合病史问询调查骨折发生。结果 绝经后妇女骨质疏松性骨折的发生率随年龄和绝经年限的延长而上升,尤其是绝经后的15-20年,骨质疏松性骨折的发生率明显升高。至少有一处以上骨折的绝经后妇女较无骨折妇女的年龄大、绝经年龄早、绝经年限长、生育次数多、哺乳月份长(P<0.01)。结论 绝经早、生育胎数多、哺乳时间长等因素是绝经后妇女骨质疏松性骨折的重要危险因素,可作为骨折高危人群的筛选指标以及制定相应干预措施的依据。     

Coffee, tea, and the risk of hip fracture: a meta-analysis

Summary

The present meta-analysis shows no clear association between coffee consumption and the risk of hip fractures. There was a nonlinear association between tea consumption and the risk of hip fracture. Compared to no tea consumption, drinking 1?4 cups of tea daily was associated with a lower risk of hip fracture.

Introduction

Prospective cohort and case–control studies have suggested that coffee and tea consumption may be associated with the risk of hip fracture; the results have, however, been inconsistent. We conducted a meta-analysis to assess the association between coffee and tea consumption and the risk of hip fracture.

Methods

We performed systematic searches using MEDLINE, EMBASE, and OVID until February 20, 2013, without limits of language or publication year. Relative risks (RRs) with 95 % confidence intervals (CI) were derived using random-effects models throughout all analyses. We conducted categorical, dose–response, heterogeneity, publication bias, and subgroup analyses.

Results

Our study was based on 195,992 individuals with 9,958 cases of hip fractures from 14 studies, including six cohort and eight case–control studies. The pooled RRs of hip fractures for the highest vs. the lowest categories of coffee and tea consumption were 0.94 (95 % CI 0.71–1.17) and 0.84 (95 % CI 0.66–1.02), respectively. For the dose–response analysis, we found evidence of a nonlinear association between tea consumption and the risk of hip fracture (p _nonlinearity?<?0.01). Compared to no tea consumption, 1–4 cups of tea per day may reduce the risk of hip fracture by 28 % (0.72; 95 % CI 0.56–0.88 for 1–2 cups/day), 37 % (0.63; 95 % CI 0.32–0.94 for 2–3 cups/day), and 21 % (0.79; 95 % CI 0.62–0.96 for 3–4 cups/day).

Conclusions

We found no significant association between coffee consumption and the risk of hip fracture. A nonlinear association emerged between tea consumption and the risk of hip fracture; individuals drinking 1–4 cups of tea per day exhibited a lower risk of hip fractures than those who drank no tea. The association between 5 daily cups of tea, or more, and hip fracture risk should be investigated.     

Coffee consumption and urologic cancer risk: a meta-analysis of cohort studies

Objectives

Controversial results were reported among several epidemiologic studies on the relationship between coffee consumption and urologic cancer risk. We, therefore, conducted this meta-analysis to clarify these associations.

Methods

Electronic databases including Pubmed, Embase and Cochrane library were searched between January 1966 and August 2013 for eligible studies. Pooled relative risk (RR) and its 95 % confidence interval (CI) were calculated. All P values are two tailed.

Results

Thirteen cohorts were eligible for inclusion. As to prostate cancer (PCa), significant reverse association was found among highest versus none/lowest analysis with acceptable heterogeneity (RR 0.86, 95 % CI 0.79–0.95; I ² 25 %, P value for heterogeneity: 0.221). A pooled RR which assessed advanced PCa was 0.73 (with 95 % CI 0.50–1.07), and a slight stronger reverse association was found in fatal PCa. However, a slight insignificant reverse association, basing on 8 studies with 9 outcomes, was found in dose–response analysis (RR 0.98, 95 % CI 0.93–1.03). For kidney and bladder cancer, insignificant associations were found in both highest versus none/lowest analyses and dose–response analyses.

Conclusions

Our findings suggest that coffee consumption may reduce the risk of PCa. No associations were found with both bladder and kidney cancer. Further well-designed large-scaled cohort studies are warranted to provide more definitive conclusions.     

Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk

The etiologic role of dietary calcium and vitamin D intake in primary prevention of osteoporotic fractures is uncertain, despite considerable research efforts. With the aim to examine these associations with an improved precision, we used data from a large population-based prospective cohort study in central Sweden. We estimated nutrient intake from a self-administered food-frequency questionnaire filled in by 60,689 women, aged 40–74 years at baseline during 1987–1990. During follow-up, we observed 3986 women with a fracture at any site and 1535 with a hip fracture. Rate ratio of fractures (RR) and 95% CI were estimated using Cox proportional hazards models. We found no dose–response association between dietary calcium intake and fracture risk. The age-adjusted RR of hip fracture was 1.01 (95% CI 0.96–1.06) per 300 mg calcium/day and the corresponding risk of any osteoporotic fracture was 0.99 (95% CI 0.96–1.03). Furthermore, women with an estimated calcium intake below 400 mg/day and those with a calcium intake higher than 1200 mg/day both had a similar age-adjusted hip fracture risk as those with intermediate calcium intakes: RR 1.07 (95% CI 0.92–1.24) and RR 1.00 (95% CI 0.79–1.27), respectively. Vitamin D intake was not associated with fracture risk. Furthermore, women in the highest quintiles compared to the lowest quintiles of both calcium and vitamin D intake had an age-adjusted RR of 1.02 for all fractures (95% CI 0.88–1.17). Dietary calcium or vitamin D intakes estimated at middle and older age do not seem to be of major importance for the primary prevention of osteoporotic fractures in women.     

Calcium and vitamin D intake influence bone mass,but not short-term fracture risk,in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study

Summary The impact of calcium and vitamin D intake on bone density and one-year fracture risk was assessed in 76,507 postmenopausal Caucasian women. Adequate calcium with or without vitamin D significantly reduced the odds of osteoporosis but not the risk of fracture in these Caucasian women. Introduction Calcium and vitamin D intake may be important for bone health; however, studies have produced mixed results. Methods The impact of calcium and vitamin D intake on bone mineral density (BMD) and one-year fracture incidence was assessed in 76,507 postmenopausal Caucasian women who completed a dietary questionnaire that included childhood, adult, and current consumption of dairy products. Current vitamin D intake was calculated from milk, fish, supplements and sunlight exposure. BMD was measured at the forearm, finger or heel. Approximately 3 years later, 36,209 participants returned a questionnaire about new fractures. The impact of calcium and vitamin D on risk of osteoporosis and fracture was evaluated by logistic regression adjusted for multiple covariates. Results Higher lifetime calcium intake was associated with reduced odds of osteoporosis (peripheral BMD T-score ≤−2.5; OR = 0.80; 95% CI 0.72, 0.88), as was a higher current calcium (OR = 0.75; (0.68, 0.82)) or vitamin D intake (OR = 0.73; 95% CI 0.0.66, 0.81). Women reported 2,205 new osteoporosis-related fractures. The 3-year risk of any fracture combined or separately was not associated with intake of calcium or vitamin D. Conclusions Thus, higher calcium and vitamin D intakes significantly reduced the odds of osteoporosis but not the 3-year risk of fracture in these Caucasian women. Sources of support: This work was supported by grant AG1406701 from the National Institute on Aging. The National Osteoporosis Risk Assessment (NORA) was funded and managed by Merck & Co Inc.     

Bone tissue compositional differences in women with and without osteoporotic fracture

It is generally accepted that the hallmark of osteoporosis is a reduction in bone mass. There is significant overlap, however, in bone mineral density between osteoporotic and normal individuals. This study examined the chemical composition of bone tissue obtained from women who had sustained a fracture and women without fracture to determine if there are differences between the two groups. Nineteen fractured and eleven non-fractured proximal femurs were obtained, matched for age and bone volume fraction obtained from micro-computed tomography. Trabecular bone specimens were examined by Raman spectroscopy to determine measures of chemical composition. A subset of the specimens was utilized to compare locations at the fracture and regions at least 2 mm away from apparent tissue damage using Raman spectroscopy. In addition, fifteen iliac crest biopsies each were obtained from women who had sustained a fracture and from normal controls. Raman spectroscopy was used to determine measures of chemical composition of trabecular and cortical bone. The results demonstrated that femoral bone tissue in the region of visible damage had a trend towards differences compared to regions at least 2 mm from visible damage. Femoral trabecular bone in fractured women had a higher carbonate/amide I area ratio than in unfractured women. Iliac crest biopsies revealed a higher carbonate/phosphate ratio in cortical bone from women who had sustained a fracture. Results suggest that the chemical composition of bone tissue may be an additional risk factor for osteoporotic fracture.     

健康和骨质疏松女性胫骨定量超声及骨折阈值的价值

目的 用太原地区健康女性胫骨定量超声骨量（ＱＵＳ）的健康参考值,探讨诊断骨质疏松症的诊断标准及骨折阈值。方法 对太原地区的健康女性１７３６例（９￣８３岁）和骨质疏松女性１８７例（４２￣８０岁）;其中骨折患６７例,测定胫骨定量超声骨量值。结果 健康女性３０岁以前胫骨ＳＯＳ值年龄的增加而升高;３０￣４０岁达到峰值,４０岁以后胫骨ＳＯＳ值开始下降;绝经后胫骨ＳＯＳ值明显降低,与绝经时间呈负相关（ｒ＝０     

Clinical risk factors for osteoporotic fracture: A population‐based prospective cohort study in Korea

Clinical risk factors (CRFs), either alone or in combination with bone mineral density, are used to determine the fracture risk for clinical assessment and to determine intervention thresholds. Because fracture risk is strongly affected by ethnicity and population‐specific differences, we sought to identify Korean‐specific CRFs for fracture, in combination with quantitative ultrasound (qUS) measurements of the radius and tibia. A total of 9351 subjects (4732 men and 4619 women) aged 40 to 69 years were followed for a mean of 46.3 ± 2.2 months. We obtained CRF information using a standardized questionnaire and measured anthropometric variables. Speed of sound at the radius (SoSR) and tibia (SoST) were measured by qUS. Fracture events were recorded using a questionnaire, and a height‐loss threshold was used as an indicator of vertebral fracture. Relative risks were calculated by Cox regression analysis. A total of 195 subjects (61 men and 134 women) suffered low‐trauma fractures. Older age, lower body mass index (BMI), and previous fracture history were positively associated with fracture risk in both sexes. Decreased hip circumference, lack of regular exercise, higher alcohol intake, menopause, and osteoarthritis history were further independent CRFs for fracture in women. However, neither SoSR nor SoST was independently associated with fracture risk. In this study, we identified the major Korean‐specific CRFs for fracture and found that smaller hip circumference was a novel risk factor. This information will allow optimal risk‐assessment targeting Koreans for whom treatment would provide the greatest benefit. © 2010 American Society for Bone and Mineral Research     

A computer-based measure of irregularity in vertebral alignment is a BMD-independent predictor of fracture risk in postmenopausal women

SUMMARY: Prevalent fracture and BMD are core elements of fracture prediction. In this control study case, we demonstrate that a simple computer-based estimation of local irregularities in the alignment of the lumbar vertebrae independently contributes to the fracture risk, thus supplementing current diagnostic tools. INTRODUCTION: We tested the hypothesis that degree of lordosis and/or irregularity in the alignment of lumbar vertebrae could be contributors to the risk of fragility fractures. METHODS: This was a case-control analysis including 144 elderly women; 108 maintaining skeletal integrity, whereas 36 sustaining a lumbar vertebral fracture during a 7.5-year observation period. The two groups of women were carefully matched for age, BMI, spine BMD and numerous classic risk factors. Lateral X-rays of the lumbar spine were digitized and the four corner points of endplates on each vertebra from Th12 to L5 were annotated. The degree of lordosis and irregularity of vertebral alignment was assessed by image analysis software. RESULTS: Degree of lordosis was not predictive for fractures. In contrast, irregularity was significantly higher in those who later sustained a fracture (1.6 x 10(-2)vs. 2.0 x 10(-3) cm(-1), p < 0.001), and further increased upon a sustained fracture (2.8 x 10(-2) cm(-1), p < 0.001), but was unchanged in controls (1.6 x 10(-2) cm(-1)). The predictive value of irregularity was independent of classic risk factors of fractures, including BMD (p < 0.01). CONCLUSION: Our results suggest that the herein introduced simple measure of irregularities in vertebral alignment could provide useful supplement to the currently used diagnostic tools of fracture prediction in elderly women.     

Lifetime absolute risk of hip and other osteoporotic fracture in Belgian women

ObjectivesTo estimate the lifetime absolute risks of hip and other osteoporotic fracture in Belgian women aged 60 years and to examine the effect of changes in baseline population fracture risk and changes in life expectancy.Materials and methodsEstimates were performed using a Markov microsimulation model and were based on the incidence of first fracture as well as life expectancy. Baseline scenario included projected mortality rates and increasing fracture incidence by 1% per year. Alternative scenarios were performed on age, life expectancy and trends in fracture incidence. Lifetime fracture risk for osteoporotic population (T-score ≤ − 2.5) was also estimated.ResultsIn the baseline scenario, lifetime absolute risks of hip fracture and of any major osteoporotic fracture (hip, clinical vertebral or wrist) were respectively 24.8% and 44.3%. Alternative scenarios showed that when assuming no change of age-specific fracture rates over time, these lifetime risks were 18.3% and 35.2%, while these values were 20.0% and 38.3% assuming no future mortality reductions. For osteoporotic women, these values were respectively 34.5% and 51.5%.ConclusionWe conclude that absolute lifetime fracture risks are substantial and that trends in fracture incidence and changes in life expectancy have a marked impact on absolute lifetime fracture risks.     

应用FRAX预测女性骨质疏松性骨折风险的对比研究

目的应用FRAX对比女性前臂骨密度和股骨颈骨密度进行骨质疏松性骨折的风险预测。方法对行骨密度检查的女性作回顾性分析,其中行前臂骨密度检查10 519例,行股骨颈骨密度检查1 280例。根据FRAX指定的危险因子,记录研究对象的年龄、身高、体重、既往骨折史、父母髋部骨折史、吸烟史、饮酒史、长期使用类固醇激素史、类风湿性关节炎及其他继发性骨质疏松症史、前臂和股骨颈的骨密度值或T值。以每10岁年龄段分组,分别运用前臂骨密度T值及股骨颈骨密度计算FRAX评分。应用SPSS 19.0统计分析软件,两组间计量数据比较使用t检验,不符合t检验条件时使用非参数秩和检验。P0.05为差异有统计学意义。结果前臂骨密度低于股骨颈骨密度。40～50岁组骨密度T值前臂要高于股骨颈,60～80岁组骨密度T值前臂低于股骨颈,除80岁组外,其他各组差异均有统计学意义(P0.05)。40岁组前臂骨质疏松检出率低于股骨颈骨质疏松检出率;50～80岁组前臂骨质疏松检出率较高(P0.05)。40～50岁组预测主要部位骨折风险前臂要低于股骨颈;70岁组预测主要部位骨折风险系数前臂要高于股骨颈(P0.05)。40～50岁组预测髋部骨折风险前臂低于股骨颈;70岁组预测髋部骨折风险系数前臂高于股骨颈(P0.05)。结论前臂骨密度可以用于FRAX进行骨折风险的预测,但各年龄段的评估概率会与股骨颈有一定差距,还需进行深入细致更准确的研究。     

绝经后女性骨质疏松性椎体骨折与腰椎体骨密度的相关性

随着我国步入老龄化社会,骨质疏松症的患病率明显升高。骨质疏松症最严重的危害来自骨质疏松性骨折,绝经后女性尤其多见。由于脊柱独特的解剖学和生物力学特点,骨质疏松患者更易发生椎体骨折。骨密度测量是诊断骨质疏松的金标准。本文通过回顾近年来相关文献,探讨腰椎体骨密度检测对绝经后女性骨质疏松性椎体骨折的意义,发现:绝经后骨质疏松性椎体骨折患者的BMD水平比绝经后骨质疏松症但无脊椎骨折者明显减少;绝经后骨质疏松症患者的BMD水平越低,其发生椎体骨折的风险越高;有椎体骨折史的绝经后骨质疏松症患者的BMD水平与发生再次椎体骨折的风险呈负相关。药物干预通常可明显提高绝经后骨质疏松症患者的BMD水平,同时还可减少椎体骨折的发生。尚存在一些不足:腰椎骨密度可能出现假性增高;需进一步探讨预测骨质疏松性椎体骨折的骨密度阈值;药物干预的研究中BMD水平与椎体骨折发生的相关性并没有得到深入研究;缺少大规模的绝经后骨质疏松性椎体骨折的流行病学,现有研究也大都存在病例收集方法不规范、样本量小、年龄分布存在差异等不足。对绝经后骨质疏松性椎体骨折的深入研究需要多学科共同协作。     

Homocysteine and fracture risk in postmenopausal women: the OFELY study

Summary Homocysteine has recently been described as an independent risk factor for osteoporotic fractures in the elderly. We prospectively followed 671 postmenopausal women belonging to the OFELY study, mean age 62 years, during a mean follow-up of 10 years. After adjustment for age, there was no significant relation between the plasma level of homocysteine and the subsequent risk of fracture. Introduction Plasma homocysteine increases with age. Recent studies have described homocysteine as an independent risk factor for osteoporotic fractures in elderly. We investigated the role of plasma homocysteine in the subsequent risk of fractures in healthy ambulatory postmenopausal women. Methods Homocysteine was measured at baseline in 671 postmenopausal women from the OFELY cohort (mean age 62.2 ± 9 years). Incident clinical fractures were recorded during annual follow-up and vertebral fractures were evaluated with radiographs every four years. A cox proportional hazards model based on time to first fracture was used to calculate hazard ratios for quartiles of homocysteine values. Results Mean homocysteine was 10.6 ± 3.4 μmol/l, increasing with age. After adjustment for age, homocysteine was significantly associated with physical activity, calcium intake, serum albumin and serum creatinine but not with bone turnover markers and bone mineral density. During a mean follow-up of 10 years, 183 fractures occurred among 134 women. After adjustment for age, the overall relative risk of fracture for each 1 SD increment of homocysteine was 1.03 (95%CI 0.87–1.31). Fracture risk was higher in women with homocysteine in the highest quartile without adjustment but no longer after adjustment for age. Conclusions Homocysteine is not an independent risk factor of osteoporotic fractures in healthy postmenopausal women from the OFELY cohort with a broad age range.