We analyzed the effect of strontium ranelate treatment on plasma homocysteine (Hcy) levels in postmenopausal osteoporotic women. Forty-nine postmenopausal women diagnosed with osteoporosis with a mean age of 54.07 +/- 7.5 years (range 40-70) who visited our menopause clinic were participated in this prospective study. Patients with bone mineral density (BMD) at least 2.5 SD below the average value in young adults (T score < -2.5) were considered to have osteoporosis. Patients received strontium ranelate 2 g/day (Servier) orally with additional calcium supplements. Fasting plasma Hcy levels were assessed at baseline, 3, 6 and 12 months of the therapy with strontium ranelate. The mean plasma Hcy level (10.45 micromol/l) after 3 months of therapy was significantly lower compared to the basal plasma Hcy level (12.61 micromol/l) (P = 0.002). The plasma homocysteine level (10.54 micromol/l) of the 43 patients that were present at the 6 months of the therapy was also significantly lower compared to the basal plasma Hcy level (P = 0.005). At the end of the 12 months of the study, there were 42 patients. The plasma homocysteine level (10.107 micromol/l) at 12 months of therapy was also significantly lower compared to the basal Hcy level (P < 0.001). Strontium ranelate 2 g/day treatment for 1 year significantly decreases plasma Hcy levels in postmenopausal women with osteoporosis. Since the increased Hcy levels could lead to an increase risk of osteoporosis and fracture risk, this effect of strontium ranelate on Hcy level may cause additional benefit in terms of reducing the risk of fracture.