Clinical Outcomes of Internal Iliac Artery Interruption during Endovascular Aneurysm Repair

Purpose@#This study aimed to investigate the clinical outcomes of internal iliac artery (IIA) interruption during endovascular aneurysm repair (EVAR) and to identify the risk factors for ischemic complications. @*Materials and Methods@#Endovascular treatment was performed in 316 patients with aneurysms or pseudoaneurysms of the abdominal aorta or iliac arteries between March 2006 and January 2022. Medical records and radiological imaging studies were retrospectively reviewed. The incidences of buttock claudication, ischemic colitis, and spinal cord ischemia after IIA interruption were investigated as clinical outcomes. Binary logistic regression analysis were performed to identify the risk factors. @*Results@#IIA embolization was performed in 78 patients. Among the 42 patients who underwent IIA flow preservation procedures, the one-month computed tomography detected early failure in five patients. The origin of the IIA was covered with an endograft in ten patients who did not undergo embolization. Eventually, interruption of the IIA by EVAR was observed in 93 patients. Considering preoperative IIA occlusion, there was a total of six patients who did not have at least one IIA patency. Buttock claudication occurred in 32.6% of the patients, and none of the patients had ischemic colitis or spinal cord ischemia. In multivariable analysis, age ≤80 years and isolated iliac artery aneurysm were associated with the development of postoperative buttock claudication. @*Conclusion@#The most common complication after IIA interruption is buttock claudication; however, critical complications such as ischemic colitis or spinal cord ischemia are rare, even in bilateral IIA occlusion. Adjunctive procedures to preserve bilateral IIA perfusion should be adopted selectively.

Type Ic Endoleak after LifeStream Balloon-Expandable Stent Graft and Zenith Iliac Branch Device Placement

Considering the recent advancements in endovascular management of aortoiliac aneurysms, the use of an iliac branch device (IBD) to preserve pelvic blood flow and reduce complications caused by embolization of the internal iliac artery (IIA) is recommended by various guidelines. Although the outcomes reported following IBD placement are mainly positive and durable, IBD-specific complications such as a type Ic endoleak and associated reintervention may occur. Moreover, only one IBD device and one type of balloon-expandable bridging stent graft for IIA are currently available on the domestic market. Here we present two cases of type Ic endoleak following IBD placement. In both cases, IIA diameter was slightly larger than the basic instructions for use. Notably, the initial procedures were considered successful; however, type Ic endoleaks were detected on 1-month follow-up imaging. This finding emphasizes the need for a precise preoperative evaluation, intraoperative manipulation, and postoperative follow-up.

Right Gastroepiploic Artery Transposition for a Common Hepatic Artery and Proper Hepatic Artery Aneurysm Repair

Although hepatic artery aneurysms (HAAs) are uncommon, they are associated with risk of rupture. HAAs >2 cm in diameter require endovascular or open surgical repairs. For HAAs involving the proper hepatic artery or gastroduodenal artery, which is a collateral artery from the superior mesenteric artery, hepatic arterial reconstruction is especially important to avoid ischemic liver injury. In this study, right gastroepiploic artery transposition was performed in a 53-year-old man after a 4 cm common hepatic artery and proper hepatic artery aneurysm was identified. The patient was discharged without any complications on postoperative day 8.

Prevalence and pathologic study of porcine epidemic diarrhea in Jeju

From April 2014 to September 2015, 153 piglets from 52 farms in Jeju were diagnosed with porcine epidemic diarrhea (PED). The major PED cases were focused on suckling piglets (144 piglets, 94.1%), particularly in 1-7-day-old piglets. Histopathologically, severe villous atrophy was observed in the small intestine, especially in the jejunum and ileum. The mean villous height to crypt depth ratios of the jejunum and ileum were 1.4:1 and 1.5:1, respectively. The major histopathologic findings of the small intestine were cytoplasmic vacuolation, cuboidalization, squamation, and exfoliation of the mucosal enterocytes in the villi. The cytoplasmic vacuolations in the enterocytes were the most prevalent lesions in the small intestine and were more severe in the ileum than in the jejunum. According to immunohistochemistry methods, the PED virus (PEDV) antigens were presented in the cytoplasms of the enterocytes, and were distributed more prevalently in the ileum than in the jejunum. PEDV antigens were also detected in the colon of 29 piglets (19.5%). Sequence comparison and phylogenetic analysis indicated that 12 PEDV had more than a 98.9% homology with each other. These PEDV strains were highly homologous with the genogroup 2 North American group.

Relationship Between Prostate Volume and Lower Urinary Tract Symptom in Health Checkup Subjects

Purpose@#This study aimed to evaluate the relationship between prostate volume and lower urinary symptom (LUTS) in subjects undergoing health checkup and to know the usefulness of TRUS in health screening. @*Materials and Methods@#The study was conducted in 883 men aged ≥20 years who underwent TRUS for health screening. All participants had filled in the international prostate symptom score (IPSS) and were tested for prostate-specific antigen; prostate volume, central gland volume, and transitional zone index were measured using TRUS. We analyzed the differences in the IPSS by prostate volume and differences in prostate volume by severity of LUTS and correlation between prostate volume and each component of IPSS. @*Results@#There were differences in the total IPSS, storage score, and voiding score between the subjects with prostate volumes of ≥30 mL or not (p=0.027, p=0.037, and p=0.029, respectively). However, the differences were found only for urgency and weak stream. The volume of the severe symptom group was bigger than those of the mild and moderate symptom groups (p=0.002 and p=0.014). The correlation between prostate volume and IPSS was significant only for the between the central volume and nocturia (r=0.112, p＜0.01). @*Conclusions@#The relationship between prostate volume and urinary symptoms showed significant but low correlation and found only in some components. For the accurate diagnosis, it would be more useful to accompany various voiding-related surveys in addition to TRUS during health screening. (Korean J Urol Oncol 2020;18:53-60)

Risk of Metabolic and Cardiovascular Risk Factors in Individuals with Autonomic Imbalance Measured by Heart Rate Variability

Background@#Studies have reported that reduced autonomic nervous system activity could result in a suboptimal health condition and various diseases, further increasing the mortality rate. The present study aimed to determine the difference in risk factors for metabolic and cardiovascular diseases in patients with reduced or unstable autonomic activity according to heart rate variability test results. @*Methods@#We recorded blood pressure, physical measurements (body mass index and waist circumference), fasting blood glucose, and blood lipid status. Indicators representative of autonomic nerve functionality (total power [TP], standard deviation of the normal-to-normal intervals [SDNN], low-frequency band [LF], high-frequency band [HF]) were measured using a 5-minute heart rate variability test. Each indicator was divided into quartiles. @*Results@#In men, the risk of abdominal obesity was high in the group with a low TP. In the group with a low SDNN, TP, and LF, the risk of a blood pressure increase was high. When LH and HF were low, there was a high risk of increased fasting blood sugar, whereas when LH was low, there was a high risk of hypertriglyceridemia. Women with SDNN loss had higher odds ratios for abdominal obesity and low high-density lipoprotein cholesterolemia. @*Conclusions@#These results indicate a higher risk of having risk factors for metabolic and cardiovascular diseases, such as abdominal obesity, elevated blood pressure, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterolemia in a group with reduced autonomic activity measured by heart rate variability. Women with a low SDNN had a 4.51-fold higher risk of abdominal obesity than women with a high SDNN, showing the greatest value of the heart rate variability indices.

Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks / 가정의학회지

One-third of the global population aged 15 years and older engages in insufficient physical activities, which affects health. However, the health risks posed by sedentary behaviors are not well known. The mean daily duration of sedentary behavior is 8.3 hours among the Korean population and 7.7 hours among the American adult population. Sedentary lifestyles are spreading worldwide because of a lack of available spaces for exercise, increased occupational sedentary behaviors such as office work, and the increased penetration of television and video devices. Consequently, the associated health problems are on the rise. A sedentary lifestyle affects the human body through various mechanisms. Sedentary behaviors reduce lipoprotein lipase activity, muscle glucose, protein transporter activities, impair lipid metabolism, and diminish carbohydrate metabolism. Furthermore, it decreases cardiac output and systemic blood flow while activating the sympathetic nervous system, ultimately reducing insulin sensitivity and vascular function. It also alters the insulin-like growth factor axis and the circulation levels of sex hormones, which elevates the incidence of hormone-related cancers. Increased sedentary time impairs the gravitostat, the body’s weight homeostat, and weight gain, adiposity, and elevated chronic inflammation caused by sedentary behavior are risk factors for cancer. Sedentary behaviors have wide-ranging adverse impacts on the human body including increased all-cause mortality, cardiovascular disease mortality, cancer risk, and risks of metabolic disorders such as diabetes mellitus, hypertension, and dyslipidemia; musculoskeletal disorders such as arthralgia and osteoporosis; depression; and, cognitive impairment. Therefore, reducing sedentary behaviors and increasing physical activity are both important to promote public health.

Association between Colorectal Adenoma and Hand Grip Strength in the Elderly

BACKGROUND: Obesity is known as an important risk factor for colorectal adenoma. However, for the elderly with changes in body composition, reduced muscle, and increased fat, the body mass index (BMI), one of the most commonly used indicators of obesity, is limited in predicting a link to colorectal cancer. This study aimed to investigate the relationship between colorectal adenoma and grip strength that can predict muscle reduction in the elderly. METHODS: This study included 262 participants aged ≥65 years who underwent medical examination between June 2015 and August 2018. The control group comprised participants with normal findings or hyperplasia and other benign lesions, except adenoma on colonoscopy, whereas the adenoma group consisted of participants with more than one adenoma. Grip strength was alternately measured twice for each hand using a hydraulic dynamometer. RESULTS: The grip strength was statistically lower in the adenoma group than in the control group among women (P=0.042). For both sexes, grip strength was significantly lower in participants with ≥5 adenomas than in those with <5 adenomas (P=0.021, P=0.007). Similarly, men with large adenomas (≥7 mm) exhibited significantly lower grip strength than did those with small adenomas (<7 mm) (P=0.004). Even after correction for age, BMI, smoking status, alcohol consumption, exercise, insulin resistance, hypertension, and diabetes, the negative correlation between grip strength and number of adenomas among men and women remained (P=0.034, P=0.019). CONCLUSIONS: A significant relationship between hand grip strength and number of colorectal adenomas was noted.

Change in the Prevalences and Risk Factors of Atrophic Gastritis and Intestinal Metaplasia in Korea: Multicenter Clinical Trials

BACKGROUND/AIMS: The aim of this study was to analyze the trend of the prevalences of atrophic gastritis (AG) and intestinal metaplasia (IM) from 2011 to 2016~2017 in Korea. And, the risk factors of AG and IM were compared between 2011 and 2016~2017. MATERIALS AND METHODS: A total of 4,023 subjects in 2011 and 2,506 subjects in 2016~2017 were enrolled. AG and IM were diagnosed on the basis of endoscopic findings. Multivariate analysis was performed for risk factors of AG and IM. Seventeen factors were analyzed. RESULTS: The seroprevalence of Helicobacter pylori decreased from 2011 (59.8%; 2,407/4,023) to 2016~2017 (51.6%; 1,293/2,506; P < 0.001). The prevalence of AG decreased from 2011 to 2016~2017 (P=0.018), but that of IM increased (P < 0.001). The risk factors of AG in 2011 were male sex, old age, H. pylori immuoglobulin G (IgG) positivity, family history of gastric cancer (GC), and high-salt diet. For IM in 2011, the risk factors were male sex, old age, H. pylori IgG positivity, and family history of GC. Risk factors of AG in 2016~2017 were old age, H. pylori IgG positivity, and country of residence. For IM in 2016~2017, the risk factors were male sex, old age, family history of GC, high fasting glucose level (≥126 mg/dL), H. pylori IgG positivity, and low income level. CONCLUSIONS: The difference in prevalence trends of AG and IM between 2016~2017 and 2011 could be the result of the different risk factors of AG and IM, such as decreased prevalence of H. pylori infection.

Prevalence and Risk Factors of Functional Dyspepsia in Health Check-up Population: A Nationwide Multicenter Prospective Study

BACKGROUND/AIMS: Functional dyspepsia (FD) is one of the most common gastrointestinal disorders, and FD imposes social and economic burden worldwide. The aim of this study is to identify the prevalence and risk factors of FD in health check-up population in tertiary centers in Korea. METHODS: A nationwide multicenter prospective study was performed at 9 tertiary healthcare centers in Korea between September 2016 and June 2017. A total of 2525 subjects were investigated based on endoscopic findings and questionnaires with the Rome III criteria, and Helicobacter pylori serology (IgG). RESULTS: A total of 1714 subjects without organic disease were enrolled. The mean (± SD) age was 51.5 (± 12.7) years, and 917 patients (53.5%) were female. The proportion of H. pylori seropositivity was 51.0% (874/1714). The prevalence of FD was 10.3% (176/1714), and the subtypes of postprandial distress syndrome alone, epigastric pain syndrome alone, and postprandial distress syndrome-epigastric pain syndrome overlap were 4.8%, 3.0%, and 2.5%, respectively. Multivariate analysis showed that female gender (OR, 1.58; 95% CI, 1.14–2.21) and education below college level (OR, 1.45; 95% CI, 1.01–2.07) were related to FD. Multivariate analysis based on age 60 showed female gender as a significant (OR, 2.90; 95% CI, 1.06–7.94) factor in the group ≥60 years. CONCLUSIONS: The prevalence of FD was 10.3% in the health check-up population in Korea. Female sex and education below college level were risk factors for FD. Female sex is a risk factor for FD in old age, underscoring the need for close attention in this age group.

Male Nurses' Experiences of Being Rejected in Nursing Practice / 한국간호교육학회지

PURPOSE: The purpose of this study is to examine and share experiences of male nurses who have been rejected during their nursing practice by their patients. METHODS: The participants were 12 male nurses who have worked in several hospitals. Data were collected through personalized in-depth interviews. Collected data were analyzed with the content analysis method. RESULTS: The results can be categorized into three main themes. 1. Rejection based on gender stereotypes of nurses' roles. 2. Nurses' reactions when nursing was rejected 3. Reestablishing the role as a nurse. The results of this study showed that male nurses were struggling to maintain their own positions as professional nurses. They were refused by their patients and they experienced a lack of skill and knowledge in nursing practice. They were harmed physically and psychologically from being turned down, and sometimes they had serious conflicts with female nurses. Meanwhile, the male nurses tried to be faithful to their role as professional nurses. CONCLUSION: The results of this study show the following findings. 1. The male nurses' experiences where mostly ones of understanding and cooperation with patients' caregivers. 2. The need for public relations advertising and systematic support from the media. 3. The need for improving gender equality for nurses. 4. Strengthening male nursing students' endeavors for sound nursing professionalism.

Low Muscle Mass and Depressed Mood in Korean Adolescents: a Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys

BACKGROUND: Muscle mass and muscle function are related to depressed mood in studies of adults. Like adults, Korean students are highly likely to suffer from decreased muscle mass due to social conditions. In this study, we evaluated the muscle mass status of Korean adolescents and assess the effect of muscle on depressive mood. METHODS: A total of 1,233 adolescent boys and girls participants from the Korea National Health and Nutrition Examination Survey were enrolled in our study. Participants underwent dual-energy X-ray absorptiometry for assessment of appendicular muscle mass and completed questionnaires regarding depressed mood, stress, suicidal ideations, and attempts. RESULTS: There was no difference in depressive mood according to muscle mass among boys (P = 0.634); girls with decreased muscle mass had a greater tendency for depressed mood compared to girls with optimal muscle mass (P = 0.023). After adjusting for age, waist circumference-to-height ratio, smoking status, alcohol consumption, frequency of physical activity, self-reported obesity, weight-loss efforts, and monthly household income, girls with low muscle mass (LMM) were 2.60 times more at risk of developing depression than girls with normal muscle mass (95% confidence interval [CI], 1.05–6.49; P = 0.040). This trend was similar for girls with LMM with obesity (95% CI, 1.00–11.97; P = 0.049). CONCLUSION: Adolescent girls who have insufficient muscle mass are more likely to report depressed mood than girls who have ideal muscle mass. Interventions for maintaining proper muscle mass are required.

Concept Analysis of Tacit Nursing Knowledge

PURPOSE: The purpose of this qualitative study is to investigate the nature of tacit nursing knowledge practiced in the clinical field in Korea using hybrid models, and to clarify the definitions and attributes of the concept. METHODS: The definition and nature of tacit nursing knowledge, obtained through a review of the extensive literature at the theoretical stage of the research, and the analysis of the in-depth interview data conducted by the career nurses in the fieldwork stage, are compared and analyzed. RESULTS: The tacit nursing knowledge was found in three dimensions as knowledge related to the person, the clinical situation work context, the self, the others, and the task. The tacit nursing knowledge was defined as personal nursing knowledge and artistic skills that show up as unconscious behavior patterns, learned informally, and internalizedthrough repeated clinical practice experience based on professional nursing knowledge. CONCLUSION: Tacit nursing knowledge has been widely used in clinical practice and has been shown to have a great impact, directly or indirectly, on clinical nursing. Therefore, individual and organizational efforts are needed for validation and clarification using the generation, sharing, collection, and peer review of sound implicit nursing knowledge to ensure that it is properly applied.

Current Status of the Resident Education Program and the Necessity of a General Competency Curriculum / 의학교육논단

In order to adapt to the rapidly changing medical environment, it is important to advance not only the basic medical education in medical schools but also that of residents. The quality of the training environment and educational goals for residency must also be improved for specialists. Although each institute including internal medicine, general surgery, family medicine, etc., strives to standardize, sets educational goals, and develops content to train capable specialists, the education programs focus on special techniques and competency of medical care for patients. The training environment of each residency program is different in each trainee hospital, and hospitals are making an effort to set education goals for the residents and improve their education programs. In Korea, there is no common core education program for residents, while in the United States, the Accreditation Council for Graduate Medical Education is responsible for the development and evaluation of a standardized curriculum for residents, and in Canada, CanMEDs presents a basic curriculum to help residents develop competency. Fully capable specialists have more than just clinical competency; they also need a wide range of abilities including professionalism, leadership, communication, cooperation, in addition to taking part in continuous professional development/continuing medical education activities. We need to provide a core curriculum for residency to demonstrate attention to and knowledge about health problems of the community.

Improving Doctor-Patient Communication / 의학교육논단

No abstract available.

Association of Coffee Consumption with Sarcopenia in Korean Elderly Men: Analysis Using the Korea National Health and Nutrition Examination Survey, 2008–2011 / 가정의학회지

BACKGROUND: Sarcopenia is an age-related loss of muscle mass and strength. Coffee has antioxidant and anti-inflammatory properties that have been shown to be inversely related to the mechanism of sarcopenia. While there have been some studies on the effect of coffee on sarcopenia in animals, studies on the topic in humans are rare. Therefore, we investigated this relationship in elderly Korean men. METHODS: The cross-sectional data were derived from the 2008–2011 Korea National Health and Nutrition Examination Survey. After applying the exclusion criteria, the study sample consisted of 1,781 men who were at least 60 years of age. Study participants were identified as having sarcopenia if their appendicular skeletal muscle mass divided by height squared was less than two standard deviations below the gender-specific mean of this value for young adults. Daily coffee consumption amounts were categorized as <1 cup, 1 cup, 2 cups, and ≥3 cups. RESULTS: Compared to the group of individuals who drank less than one cup of coffee a day, people who consumed at least 3 cups (adjusted odds ratio, 0.43; 95% confidence interval, 0.20 to 0.94) showed significantly decreased sarcopenia; however, the decrease was not significant when the daily coffee consumption was 1 or 2 cups. In multivariate logistic regression models, significant associations were observed between sarcopenia and coffee consumption (P for trend=0.039). CONCLUSION: The results of this study suggest that consuming at least 3 cups of coffee per day was associated with a lower prevalence of sarcopenia in elderly Korean elderly men.

The Association between Hand Grip Strength and Health-Related Quality of Life in Korean Adults / 대한스포츠의학회지

We investigated the association between hand grip strength (HGS) and health-related quality of life (HRQOL). A total number of 9,211 participants from the sixth Korean National Health and Nutrition Examination Survey (2014– 2015) were included. HRQOL was measured by EuroQol-5 dimension (EQ-5D) and EQ-5D index score. Participants were classified as normal HRQOL group or impaired HRQOL group according to the EQ-5D responses and the EQ-5D index scores. HGS was measured using Takei dynamometer. Impaired HRQOL group represented lower mean HGS than that of normal HRQOL group. According to the quintile groups of HGS, group with the lowest HGS showed the lowest mean EQ-5D index score in both sexes. And the more HGS increases, the more EQ-5D index score increases also (p-value for trend <0.001). Men and women with lower grip strength were more likely to report ‘some’ or ‘extreme problem’ in EQ-5D domains (except anxiety/depression and pain/discomfort domain in men), and also more likely to belong to the lowest 20% level group in EQ-5D index score according to logistic analyses. Our findings suggest that HGS is associated HRQOL. Low HGS is associated with impaired status of HRQOL by EQ-5D and EQ-5D index score in Korean men and women. More research is needed to evaluate the specific plausibility between HGS and HRQOL.

The Association between Sitting Time and Health-Related Quality of Life According to Body Mass Index in Elderly Korean

BACKGROUND: Although obesity and health-related quality of life (HRQOL) in elderly are well known to be associated with obesity and sitting time, it is unclear whether effect of sedentary lifestyle on HRQOL is affected by body mass index (BMI) or not. So we analyzed the relationship between sitting time and HRQOL according to BMI groups in elderly Korean. METHODS: Participants aged over 60 from the 6th Korea National Health and Nutrition Examination Survey (2014 and 2015) were included. Participants were classified as normal weight and overweight/obese groups. Mean sitting times were compared between groups according to the EuroQol 5 dimension (EQ-5D) And logistic regression analyses were performed. RESULTS: Men with mobility, usual activity, or pain/discomfort domain problem had longer sitting time. Women with a problem in every domain had longer sitting time. Overweight/obese women with problem showed longer sitting time. Odds ratios (ORs) of mobility, usual activity, pain or discomfort, and low EQ-5D score domain were increased regardless of BMI groups in men. But, ORs of all domains were increased only in overweight/obese group in women. CONCLUSIONS: In elderly Korean, prolonged sitting time associated with decreased HRQOL. Impaired HRQOL is associated with increased sitting time regardless of BMI in men. But only overweight/obese group showed association between prolonged sitting time and impaired HRQOL in women. These results represents that decrease in quality of life according to the increase of the sitting time differs according to the BMI in elderly Korean women.

Effects of Horticultural Therapy for the Korean Elderly : A Systematic Literature Review

PURPOSE: This study was conducted to ascertain the effectiveness of horticultural therapy by analyzing researches on horticultural therapy applied to elderly Koreans. METHODS: We evaluated 401 research papers including dissertations on horticultural therapy applied to elderly Koreans from Jan. 2000 to Feb. 2016. We reviewed the appropriate 12 papers among them for the final analysis. RESULTS: Horticultural therapy had physiological and psychosocial effects. First of all, it showed the physiological effects of reducing stress hormones. Outdoor horticultural therapy improved the gross motor movements of the body. Indoor horticulture therapy improved delicate cognitive & operating functions. Second, horticultural therapy showed the psychosocial effects of reducing depression and improving cognitive functions, language abilities, comprehension, daily activity, life satisfaction and sociality. But the effects appeared differently dependent on the implementation protocol & period of horticultural therapy, as well as the professionalism of the therapists. Therefore, if horticultural therapy were to be administered through nursing, it should be based on its key principle, in other words, the principle of action-interaction-response of horticultural therapy. CONCLUSION: The results of this study will be useful for developing therapeutic interventions through nursing. Also they will be helpful in applying horticultural therapy programs in nursing practice.

Association between Homocysteine and Bone Mineral Density according to Age and Sex in Healthy Adults

BACKGROUND: There are several studies about the relationship between serum homocysteine levels and bone mineral density (BMD), but the results are varied, and the studies are limited in Korea. In our study, the relationship between serum homocysteine levels and BMD by part according to age and sex is investigated. METHODS: From March 2012 to July 2015, the 3,337 healthy adults who took a medical examination were recruited. Subjects filled in the self-recording type questionnaire and physical examination, blood test, BMD of lumbar spine and femur were measured. After sorting by aging (≤49 year old, 50-59 year old, ≥60 year old) and sex, the results were adjusted with age and body mass index (BMI) and the relationship between serum homocysteine levels and BMD by lumbar spine and femur was analyzed by multiple regression analysis. RESULTS: As results of analysis, with the adjustment with age and BMI, all age groups of men had no significant relationship between log-converted serum homocysteine levels and BMD. In women aged under 50, there were significantly negative relationships at lumbar spine (β=-0.028, P=0.038), femur neck (β=-0.062, P=0.001), and total hip (β=-0.076, P<0.001), but there was no significant relationship in other age groups (50-59 year old and ≥60 year old). CONCLUSIONS: As the serum homocysteine levels increased in women aged under 50, BMD of the lumbar spine and femur decreased, and correlations between homocysteine and BMD were different by sex and age.