Abstract
The C677T (rs1801133) polymorphism of MTHFR (methylenetetrahydrofolate reductase)
has been associated with the risk of cardiovascular events, and also with osteoporosis
in some studies. However, the results are controversial. Our objective was to determine
the relationship of the polymorphism with osteoporotic fractures by means of a case-control
study. C677T was analyzed in 823 subjects (365 controls, 136 with vertebral fractures
and 322 with hip fracture) by using a Taqman assay. The distribution of MTHFR genotypes
was similar in patients and controls. In comparison with TC/CC genotypes, the age-adjusted
OR for hip fractures of the TT genotype was 1.0 (95% confidence interval 0.6-1.7)
in women and 0.7 (0.3-1.8) in men. The OR for vertebral fractures was 0.8 (0.4-1.7)
in women and 1.7 (0.4-6.7) in men. A meta-analysis combining these data with previous
reports confirmed the lack of association between MTHFR and fractures, with an OR
of 1.1 (0.7-1.9, p=0.65) for vertebral fractures and 1.2 (0.7-2.0; p=0.45) for peripheral
fractures, but there was significant heterogeneity among the results of individual
studies, particularly about peripheral fractures. In conclusion, the C677T polymorphism
of the MTHFR gene does not appear to be associated with the overall risk of osteoporotic
fractures. However, given the heterogeneity of the results of published studies, further
investigations are needed to evaluate its influence in specific population subgroups.
Key words
Osteoporosis - methylenetetrahydrofolate reductase - homocysteine - meta-analysis
References
- 1
Hamerman D.
Osteoporosis and atherosclerosis: biological linkages and the emergence of dual-purpose
therapies.
QJM.
2005;
98
467-484
- 2
Jorgensen L, Joakimsen O, Rosvold Berntsen GK, Heuch I, Jacobsen BK.
Low bone mineral density is related to echogenic carotid artery plaques: a population-based
study.
Am J Epidemiol.
2004;
160
549-556
- 3
Wald DS, Law M, Morris JK.
Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis.
BMJ.
2002;
325
1202-1207
- 4
MacLean RR, Jacques PF, Selhub J, Tucker KL, Samelson EJ, Broe KE. et al .
Homocysteine as a predictive factor for hip fractures in older persons.
N Engl J Med.
2004;
350
2042-2049
- 5
Meurs JBJ Van, Dhonukshe-Rutten RAM, Pluijm SMF, Klift M Van der, Jonge R de, Lindemans J.
et al .
Homocysteine levels and the risk of osteoporotic fracture.
N Engl J Med.
2004;
350
2033-2041
- 6
Casas JP, Bautista LE, Smeeth L, Sharma P, Hingorani AD.
Homocysteine and stroke: evidence on a causal link from mendelian randomisation.
Lancet.
2005;
365
224-232
- 7
Miyao M, Morita H, Hosoi T, Kurihara H, Inoue S, Hoshimo S. et al .
Association of methylenetetrahydrofolate reductase (MTHFR) polymorphism with bone
mineral density in postmenopausal Japanese women.
Calcif Tissue Int.
2000;
66
190-194
- 8
Villadsen MM, Bünger MH, Carstens M, Stenkjaer L, Langdahl BL.
Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is associated with
osteoporotic vertebral fractures, but is a weak predictor of BMD.
Osteoporos Int.
2005;
16
411-416
- 9
MacLean RR, Karasik D, Selhub J, Tucker KL, Ordovas J, Russo GT. et al .
Association of a common polymorphism in the methylenetetrahydrofolate reductase (MTHFR)
gene with bone phenotypes depends on plasma folate status.
J Bone Miner Res.
2004;
19
410-418
- 10
MacDonald HM, MacGuigan FE, Fraser WD, New SA, Ralston SH, Reid DM.
Methylenetetrahydrofolate reductase polymorphism interacts with riboflavin intake
to influence bone mineral density.
Bone.
2004;
35
957-964
- 11
Abrahamsen B, Jorgensen HL, Nielsen TL, Andersen M, Haug E, Schwarz P. et al .
MTHFR c.677C>T polymorphism as an independent predictor of peak bone mass in Danish
men-results from the Odense Androgen Study.
Bone.
2006;
38
215-219
- 12
Abrahamsen B, Madsen JS, Tofteng CL, Stilgren L, Bladbjerg EM, Kristensen SR. et al
.
A common methylenetetrahydrofolate reductase (C677T) polymorphism is associated with
low bone mineral density and increased fracture incidence after menopause:longitudinal
data from the Danish osteoporosis prevention study.
J Bone Miner Res.
2003;
18
723-729
- 13
Bathum L, Bornemann-Hjelmorbg J von, Christiansen L, Madsen JS, Skytthe A, Christensen K.
Evidence for an association of methylene tetrahydrofolate reductase polymorphism C677T
and an increased rsik of fractures: results from a population-based Danish study.
Osteoporos Int.
2004;
15
659-664
- 14
Jorgensen HL, Madsen JS, Madsen B, Saleh MMA, Abrahamsen B, Fenger M. et al .
Association of a common allelic polymorphism (C677T) in the methylene tetrahydrofolate
reductase gene with a reduced risk of osteoporotic fractures. A case control study
in Danish postmenopausal women.
Calcif Tissue Int.
2002;
71
386-392
- 15
Li M, Lau EM, Woo J.
Methylenetetrahydrofolate reductase polymorphism (MTHFR C677T) and bone mineral density
in Chinese men and women.
Bone.
2004;
35
1369-1374
- 16
Molloy AM, Daly S, Mills JL, Kirke PN, Whitehead AS, Ramsbottom D. et al .
Thermolabile variant of 5,10-methylenetetrahydrofolate reductase associated with low
red-cell folates: implications for folate intake recommendations.
Lancet.
1997;
349
1591-1593
- 17
Ralston SH.
Genetic control of susceptibility to osteoporosis.
J Clin Endocrinol Metab.
2002;
87
2460-2466
- 18
Michaelsson K, Melhus H, Ferm H, Ahlbom A, Pedersen NL.
Genetic liability to fractures in the elderly.
Arch Intern Med.
2005;
165
1825-1830
- 19
Cagnacci A, Baldassari F, Rivolta G, Arangino S, Volpe A.
Relation of homocysteine, folate, and vitamin B12 to bone mineral density of postmenopausal
women.
Bone.
2003;
33
956-959
- 20
Dhonukshe-Rutten RAM, Pluijm SMF, Groot LCPM de, Lips P, Smit JH, Staveren WA van.
Homocysteine and vitamin B12 status relate to bone turnover markers, broadband ultrasound
attenuation, and fractures in healthy elderly people.
J Bone Miner Res.
2005;
20
921-929
- 21
Gjesdal CG, Vollset SE, Ueland PM, Refsum H, Drevon CA, Gjessing HK. et al .
Plasma total homocysteine level and bone mineral density: the Hordaland Homocysteine
Study.
Arch Intern Med.
2006;
166
88-94
- 22
Raisz LG.
Homocysteine and osteoporotic fractures-culprit or bystander?.
N Engl J Med.
2004;
350
2089-2090
- 23
Abrahamsen B, Madsen JS, Tofteng CL, Stilgren L, Bladbjerg EM, Kristensen SR. et al
.
Are effects of MTHFR (C677T) genotype on BMD confined to women with low folate and
riboflavin intake? Analysis of food records from the Danish osteoporosis prevention
study.
Bone.
2005;
36
577-583
- 24
Powers HJ.
Interaction among folate, riboflavin, genotype, and cancer, with reference to colorectal
and cervical cancer.
J Nutr.
2005;
135
((12 Suppl))
2960S-2966S
- 25
Ulrich CM.
Nutrigenetics in cancer research - folate metabolism and colorectal cancer.
J Nutr.
2005;
135
2698-2702
- 26
Balk EM, Raman G, Tatsioni A, Chung M, Lau J, Rosenberg IH.
Vitamin B6, B12, and folic acid supplementation and cognitive function: a systematic
review of randomized trials.
Arch Intern Med.
2007;
167
21-30
- 27
Bazzano LA, Reynolds K, Holder KN, He J.
Effect of folic acid supplementation on risk of cardiovascular diseases: a meta-analysis
of randomized controlled trials.
JAMA.
2006;
296
2720-2726
- 28
Green TJ, MacMahon JA, Skeaff CM, Williams SM, Whiting SJ.
Lowering homocysteine with B vitamins has no effect on biomarkers of bone turnover
in older persons: a 2-y randomized controlled trial.
Am J Clin Nutr.
2007;
85
460-464
- 29
Hong X, Hsu YH, Terwedow H, Tang G, Liu X, Jiang S. et al .
Association of the methylenetetrahydrofolate reductase C677T polymorphism and fracture
risk in Chinese postmenopausal women.
Bone.
2007;
40
737-742
Correspondence
J. A. Riancho
Department of Internal Medicine
Hospital U. M. Valdecilla
39008 Santander
Spain
Phone: +34/942/20 25 13
Fax: +34/942/20 16 95
Email: rianchoj@unican.es