Nutrition Pearls: Treating Osteoporosis With Vitamin B12

Alison is a 67-year-old woman with osteoporosis who takes daily calcium supplements and exercises 5 days a week. Because she has high levels of homocysteine in her blood, you recommend that she also add foods fortified with vitamin B12 to her diet.

She is reluctant to make changes to her diet, and instead asks if she can simply take oral vitamin B12 daily supplements.

How Would You Advise Your Patient?

Answer and discussion on next page.

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Answer: Eating vitamins and minerals is more beneficial than taking supplements in pill form.

When we talk to our patients about preventing or treating osteoporosis, we often focus on building bone—whether it’s by taking calcium and vitamin D supplements or through weight-bearing exercise. We don’t tend to discuss the risk factors for osteoporosis that have little or nothing to do with the bone mass created during youth and early adulthood.

Hyperhomocysteinemia

One of these fairly common risk factors is hyperhomocysteinemia—ie, high levels of homocysteine in the blood (>15 µmol/L). Hyperhomocysteinemia is related to increased risk of heart disease and bone fractures due to osteoporosis. Note: Homocysteine levels typically increase with age and are usually higher in men than women, however, reducing homocysteine levels is an attainable preventative strategy for the treatment for osteoporosis.

If consuming foods with vitamin B12 and folic acid helps reduce homocysteine levels, would taking the same supplements in an oral pill form also reduce the risk of fractures due to osteoporosis?

The Research

A team of scientists in the Netherlands recruited nearly 3000 men and women (age 65 and older) to participate in a 2-year study comparing daily oral pill supplementation with vitamin B12 and folic acid against placebo.¹ The participants were required to be living independently (although some at-home assistance was acceptable), had been diagnosed with high homocysteine levels, were not bedridden or permanently in a wheelchair, and with a cancer-free diagnosis for the 5 years prior to the start of the research.

The Results

After the 2-year study, researchers compared the number of osteoporotic fractures in individuals receiving the vitamin B12 and folic acid oral pill supplements (52 persons with 61 fractures) with those who received the placebo (61 persons with 75 fractures). After taking into account age, sex, starting homocysteine levels, and genotype, the researchers concluded that overall, there was no significant difference in risk of fracture between those who received the oral pill supplement and those who did not.

They did notice, however, that the 62 participants who receiving the supplement were diagnosed with cancer compared to only 42 individuals in the placebo group. Further analysis excluded relapses in previous diagnoses of cancer; the data still showed a significantly greater risk of all types of cancer (especially gastrointestinal and colorectal cancers ) in those taking the vitamin B12 and folic acid oral supplements.

What’s the “Take Home”?

While analyzing the participants according to age showed a slight decrease in risk of fracture among those participants under the age of 80, the increased risk of cancer outweighs the benefit. Note: This study was not designed to test whether vitamin B12 and folic acid oral pill supplementation increased the risk of cancer, so the findings should only be taken as an indication that more research is needed.

Your patients are better off eating their vitamins and minerals—not taking supplements in pill form. Good sources of vitamin B12 include beef liver, shellfish, fresh tuna, or salmon, as well as fortified cereals and milk that have been fortified with B12. Good sources of folic acid include fortified cereals and breadstuffs, green leafy vegetables (especially asparagus and broccoli), and fruits.

Reference:

1. Wijngaarden JP, Swart KM, Enneman AW, et al. Effect of daily vitamin B-12 and folic acid supplementation on fracture incidence in elderly individuals with an elevated plasma homocysteine concentration: B-PROOF, a randomized controlled trial. Am J Clin Nutr. 2014;100:1578-1586.