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To the Editor: Dr Sato and colleagues¹ reported the first evidence that treatment of elderly patients with hemiplegia following stroke and high levels of plasma homocysteine, using folate and mecobalamin (vitamin B₁₂), decreases plasma homocysteine levels and markedly reduces the risk of hip fracture. This treatment did not affect bone mineral density (BMD) or fall frequency in these patients, consistent with a recent epidemiological study² that found that high homocysteine levels in blood were associated with an increased risk of nonvertebral fractures in older people independent of BMD or recent falls. These findings suggest that the reduced fracture risk results from an improvement of bone quality, possibly countering inhibition of collagen cross-linking by homocysteine.^1-2 However, homocysteine levels are closely linked to vitamin B₁₂ levels, and serum vitamin B₁₂ levels in these patients were low at baseline and markedly increased after the treatment; therefore, vitamin B₁₂ itself might be directly . . . [Full Text of this Article]

Toshihiro Sugiyama, MD, PhD
toshihiro.sugiyama@chive.ocn.ne.jp

Hiroshi Tanaka, MD, PhD; Toshihiko Taguchi, MD, PhD
Department of Orthopedic Surgery
Yamaguchi University School of Medicine
Yamaguchi, Japan

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