Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2010:76:2;186-187
doi: 10.4103/0378-6323.60557
PMID: 20228554

Hyperhomocysteinemia: Can't it account for retinoid-induced fracture proneness?

Mohammad Reza Namazi1 , Amir Feily2
1 Department of Dermatology, Comparative Medicine Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
2 Resident of Dermatology, Jondishapur, University of Medical Sciences, Ahvaz, Iran

Correspondence Address:
Amir Feily
Department of Dermatology, Resident of Dermatology, Jondishapur University of Medical Sciences, Ahvaz
Iran
How to cite this article:
Namazi MR, Feily A. Hyperhomocysteinemia: Can't it account for retinoid-induced fracture proneness?. Indian J Dermatol Venereol Leprol 2010;76:186-187
Copyright: (C)2010 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

A substantial amount of animal studies [1],[2],[3] and some human studies have shown that retinoid use is associated with osteoporosis and an increased risk for bone fracture. [4],[5] The mechanism of this effect has been elusive. In 1986, McGuire and Lawson. [5] suggested a possible relationship of the retinoid use with elevation of some cytokines that can enhance maturation of the preosteoclasts. [5] Later on, histomorphometric evaluations revealed that activation of osteoclasts and increased subperiosteal osteoclastic bone resorption may be the mechanism of bone loss due to retinoids. [2],[3] Administration of retinol with alendronate sodium, a direct potent inhibitor of osteoclasts action, [3] lessened the preventive action of alendronate on the development of osteopenic changes in the skeletal system of ovariectomized rats. [6]

We herein suggest a hitherto unexplained mechanism for retinoid osteoporotic adverse effect and increasing risk of bone fractures that could lead to novel preventive strategies.

The aminoacid homocysteine (Hcy) is metabolized in the liver by cystathionine beta-synthase. [7] Hcy levels are shown to be elevated in patients on isotretinoin treatment for acne, which may be due to the inhibition of cystathionine beta-synthase by the drug and/or the drug-induced liver dysfunction. [7],[8] Elevated levels of Hcy have been linked to increased fracture in the elderly and have been suggested as a new risk factor for osteoporosis. [9],[10] Epidemiological and randomized clinical trials suggest that hyperhomocysteinemia increases fracture risk, but has minor effects on bone mineral density. Hcy has been found to accumulate in the bone by collagen binding and stimulate osteoclasts but not osteoblasts, thereby inducing a shift of bone metabolism toward resorption. In addition, hyperhomocysteinemia seems to have adverse effects on extracellular bone matrix by disturbing collagen crosslinking. [9]

So, putting these facts altogether, it could be suggested that retinoid-induced hyperhomocysteinemia may account for osteoclast overactivity, osteoporosis, and increased risk of bone fracture associated with retinoid use. Daily supplementation with vitamin B 12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy [7] and prevent osteoporosis [11] induced by retinoid and other potential untoward effects of hyperhomocysteinemia such as atherosclerosis.

References
1.
Hotchkiss CE, Latendresse J, Ferguson SA. Oral treatment with retinoic acid decreases bone mass in rats. Comp Med 2006;56:502-11.
[Google Scholar]
2.
Wu B, Xu B, Huang TY, Wang JR. A model of osteoporosis induced by retinoic acid in male Wistar rats. Yao Xue Xue Bao 1996;31:241-5.
[Google Scholar]
3.
Kneissel M, Studer A, Cortesi R, Susa M. Retinoid-induced bone thinning is caused by subperiosteal osteoclast activity in adult rodents. Bone 2005;36:202-14.
[Google Scholar]
4.
Leachman SA, Insogna KL, Katz L, Ellison A, Milstone LM. Bone densities in patients receiving isotretinoin for cystic acne. Arch Dermatol 1999;135:961-5.
[Google Scholar]
5.
McGuire J, Lawson JP. Skeletal changes associated with chronic isotretinoin and etretinate administration. Dermatologica 1987;175:169-81.
[Google Scholar]
6.
Sliwiñski L, Janiec W, Pytlik M, Folwarczna J, Kaczmarczyk-Sedlak I, Pytlik W, et al. Effect of administration of alendronate sodium and retinol on the mechanical properties of the femur in ovariectomized rats. Pol J Pharmacol 2004;56:817-24.
[Google Scholar]
7.
Polat M, Lenk N, Bingöl S, Oztaº P, Ilhan MN, Artüz F, et al . Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: a prospective controlled study. J Dermatolog Treat 2008;19:229-32.
[Google Scholar]
8.
Schulpis KH, Karikas GA, Georgala S, Michas T, Tsakiris S. Elevated plasma homocysteine levels in patients on isotretinoin therapy for cystic acne. Int J Dermatol 2001;40:33-6.
[Google Scholar]
9.
van Meurs JB, Dhonukshe-Rutten RA, Pluijm SM, van der Klift M, de Jonge R, Lindemans J, et al. Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med 2004;350:2033-41.
[Google Scholar]
10.
Herrmann M, Peter Schmidt J, Umanskaya N, Wagner A, Taban-Shomal O, Widmann T, et al. The role of hyperhomocysteinemia as well as folate, vitamin B (6) and B (12) deficiencies in osteoporosis: a systematic review. Clin Chem Lab Med 2007;45:1621-32.
[Google Scholar]
11.
Cashman KD. Homocysteine and osteoporotic fracture risk: A potential role for B vitamins. Nutr Rev 2005;63:29-36.
[Google Scholar]

Fulltext Views
1,264

PDF downloads
553
Show Sections