vitamin-b-12 and Osteoporosis

Although there are several factors related to bone diseases such as physical activity, gender (oestrogen), race/ethnicity, smoking and alcohol habits, nutrition is a modifiable risk factor that could be employed to prevent or manage the onset of bone health diseases such as osteoporosis in humans. Aside from calcium and vitamin D, B vitamins are a group of water-soluble vitamins that play a vital role in cell metabolism. In this review, current evidence on B vitamins and bone health is assessed. Clinical trials (interventions) indicate that treatment with B vitamins impact the concentrations of total plasma/serum homocysteine concentrations (tHcy); however, most studies have reported the lack of an effect of low homocysteine concentrations on bone turnover markers, bone mineral density or fracture risks. Current studies have been inconsistent in their reports on the role of B vitamins and homocysteine in bone health. More data are therefore required to show the mechanism and effect of tHcy and B vitamins on bone mineral density, bone metabolism and fracture risk.

Topics: Bone and Bones; Bone Density; Folic Acid; Fractures, Bone; Homocysteine; Humans; Osteoporosis; Vitamin B 12; Vitamin B Complex

Proton pump inhibitors are widely used in the treatment of acid-related diseases because they are considered to be effective and safe. In the past 10 years the use of proton pump inhibitors increased by over three folds, which is not associated with the increased prevalence of acid-related diseases obviously. However, like any other drugs, they have potential side effects. In recent years many studies have been published about the correlation between long-term proton pump inhibitor therapy and the increase of bone fractures. Most studies showed that long-term proton pump inhibitor therapy moderately increased fracture risk. The underlying mechanisms of increased number of bone fractures are not clarified yet. However, chronic acid suppression caused by long-term proton pump inhibitor therapy may play a crucial role in decreased absorption of calcium and vitamin B12 and, therefore, indirectly affecting the bones resulting in a decrease of bone mineral density. The available data suggest that proton pump inhibitors should be used with caution in patients with increased risk of osteoporosis.. A protonpumpagátlók alkalmazása elterjedt a gyomorsav okozta megbetegedések kezelésében, mivel ezek a szerek meglehetősen hatékonyak és biztonságosan alkalmazhatóak. Alkalmazásuk viszont az elmúlt 10 évben több mint háromszorosára nőtt, ami egyértelműen nincs arányban a savval összefüggő kórképek növekedésével. Ez különösképpen azért is aggályos, mert a legtöbb gyógyszernek – csakúgy, mint ezeknek a szereknek is – vannak mellékhatásaik. Az utóbbi években több tanulmány is megjelent, melyekben a hosszú távú protonpumpagátló kezelés és a csonttörések gyakoriságának növekedése közötti összefüggést vizsgálták. A tanulmányok többségében kimutatták, hogy a hosszú távú protonpumpagátló kezelés kismértékben növeli a csonttörések kockázatát. A gyakoribb törések hátterében álló mechanizmusok nem tisztázottak kellőképpen, azonban valószínűleg a terápia hatására kialakuló krónikus hypoaciditas játszik benne szerepet, mely befolyásolja a kalcium és a B12-vitamin felszívódását, illetve közvetetten befolyásolja a csontrendszert is, csökkentve a csontsűrűséget. A rendelkezésre álló adatok alapján mindenképpen ajánlott az óvatosság protonpumpagátló kezelés indítása esetén olyan betegek körében, akiknél fokozott az osteoporosis kialakulásának kockázata. Orv. Hetil., 2013, 154, 1005–1009.

Topics: Bone Density; Calcium, Dietary; Drug Administration Schedule; Fractures, Bone; Gastric Acid; Humans; Intestinal Absorption; Osteoporosis; Proton Pump Inhibitors; Vitamin B 12

Vitamin B(12) is essential for DNA synthesis and for cellular energy production.This review aims to outline the metabolism of vitamin B(12), and to evaluate the causes and consequences of sub-clinical vitamin B(12) deficiency. Vitamin B(12) deficiency is common, mainly due to limited dietary intake of animal foods or malabsorption of the vitamin. Vegetarians are at risk of vitamin B(12) deficiency as are other groups with low intakes of animal foods or those with restrictive dietary patterns. Malabsorption of vitamin B(12) is most commonly seen in the elderly, secondary to gastric achlorhydria. The symptoms of sub-clinical deficiency are subtle and often not recognized. The long-term consequences of sub-clinical deficiency are not fully known but may include adverse effects on pregnancy outcomes, vascular, cognitive, bone and eye health.

Topics: Absorption; Biomarkers; Cardiovascular Diseases; Cognition Disorders; Female; Food; Humans; Male; Neural Tube Defects; Nutritional Requirements; Osteoporosis; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin B 12 Deficiency

Calcium and vitamin D are the mainstays of nutritional intervention for the prevention and treatment of osteoporosis. However, conditions that alter nutritional status as well as other nutrients should be considered when diagnosing and treating osteoporosis and osteopenia. Current research supports the early diagnosis and treatment of anorexia nervosa to prevent associated bone loss and increased risk of fracture. Weight restoration in patients with anorexia nervosa is central to bone mass stabilization. Other nutritional considerations include nutrients such as vitamin B-12 and vitamin K that may reduce fracture risk by increasing bone mineral density as well as the improvement of bone microarchitecture. Diets high in fruits and vegetables contribute nutrients such as magnesium associated with bone health and may also produce an alkaline environment, reducing calcium excretion and thus improving bone density.

Topics: Anorexia Nervosa; Bone Density; Diet; Dietary Supplements; Fruit; Homocysteine; Humans; Nutritional Requirements; Osteoporosis; Randomized Controlled Trials as Topic; Vegetables; Vitamin B 12; Vitamin K

Hyperhomocysteinemia (HHCY) has been suggested as a new risk factor for osteoporosis. Recent epidemiological, clinical and experimental studies provide a growing body of data, which is reviewed in this article. Epidemiological and (randomized) clinical trials suggest that HHCY increases fracture risk, but has minor effects on bone mineral density. Measurement of biochemical bone turnover markers indicates a shift of bone metabolism towards bone resorption. Animal studies confirm these observations showing a reduced bone quality and stimulation of bone resorption in hyperhomocysteinemic animals. Homocysteine (HCY) has been found to accumulate in bone by collagen binding. Cell culture studies demonstrate that high HCY levels stimulate osteoclasts but not osteoblasts, indicating again a shift of bone metabolism towards bone resorption. Regarding B-vitamins, only a few in vivo studies with equivocal results have been published. However, two large cell culture studies confirm the results obtained with exogenous HCY administration. In addition, HHCY seems to have adverse affects on extracellular bone matrix by disturbing collagen crosslinking. In conclusion, existing data suggest that HHCY (and possibly B-vitamin deficiencies) adversely affects bone quality by a stimulation of bone resorption and disturbance of collagen crosslinking.

Topics: Animals; Bone Density; Folic Acid Deficiency; Fractures, Bone; Humans; Hyperhomocysteinemia; Osteoporosis; Vitamin B 12; Vitamin B 6; Vitamin B Deficiency

As for any chronic disease, adherence to osteoporosis treatment is low. Folates and vitamin B12 decrease hip fracture risk in elderly Japanese with stroke. Raloxifene (Evista) decreases the incidence of positive estrogen receptor breast cancer and could prevent cardiovascular events in patients at high risk. Strontium ranelate (Protélos) prevents hip fracture in elderly women. The action of alendronate (Fosamax) on bone mineral density and markers of bone remodelling is of higher amplitude than that of risedronate (Actonel). Once monthly ibandronate (Bonviva) increases bone mineral density in post menopausal women with osteoporosis. Excessive suppression of bone remodelling and osteonecrosis of the yaws could be related to bisphosphonate intake.

Topics: Bone Density; Bone Density Conservation Agents; Bone Resorption; Chronic Disease; Folic Acid; Fractures, Bone; Humans; Osteonecrosis; Osteoporosis; Vitamin B 12

Moderate hyperhomocysteinemia (HHCY) is a risk factor for cardiovascular (CVD) and neurodegenerative diseases, osteoporotic fractures and complications during pregnancy. Elderly persons have a high prevalence of HHCY. Vitamin deficiency is by far the most common cause of HHCY. Retrospective and prospective studies emphasize a causal relationship between HHCY and the CVD risk. Some vitamin intervention trials, however, did not lower the risk of CVD. From power calculation one can conclude that these trials may not involve sufficient numbers of patients to assure statistically valid conclusions. Re-analysis of the VISP study (excluding renal failure and vitamin B12 status tampering factors), however, detected a 21% decrease in the risk of stroke. This number has been confirmed by results from the HOPE 2 vitamin intervention trial. Folic acid enrichment of grain products in the US and Canada has led to a significant decline of stroke mortality, since 1998 annually 12900 fewer stroke deaths in the US and 2800 fewer stroke deaths in Canada. Despite negative results from secondary prevention trials regarding the CVD risk reduction there is convincing evidence about the effectiveness of B-vitamin supplementation in lowering the stroke risk. The overall decline in stroke risk calculated in meta-analysis from prospective studies and found in intervention trials is around 20%. Additionally, HHCY was recently linked to the occurrence and severity of chronic heart failure. HHCY is also a risk factor for osteoporotic fractures and vitamin treatment lowered the fracture risk significantly. Furthermore, there is a correlation between HHCY and cognitive disorders or Alzheimer's disease. HHCY is a predictive parameter for the decline in cognitive function. Hypomethylation is among the central mechanisms through which HHCY acts cytotoxically. HHCY and low folate are causal factors for pregnancy complications. In addition to the recommended folate supplementation, vitamin B12 supplementation could further decrease pregnancy complications. Determination of homocysteine plasma concentration should be part of the individual risk profile, especially for elderly subjects who are at risk for CVD, neurodegenerative diseases or osteoporotic fractures.

Topics: Age Factors; DNA Methylation; Female; Folic Acid; Heart Failure; Humans; Hyperhomocysteinemia; Neurodegenerative Diseases; Osteoporosis; Pregnancy; Pregnancy Complications; Risk Factors; Vitamin B 12

Young Indian women may be at risk of poor bone health due to malnutrition. The aim of this study was to examine the effects on bone metabolism of a nutritional supplement in women aged 25 to 44. The nutritional supplement was a protein-rich beverage powder fortified with multi-micronutrients including calcium (600 mg), vitamin D (400 IU), and vitamin K (55 mcg) per daily serving, while a placebo supplement was low-protein non-fortified isocaloric beverage powder. This 6-month randomised, controlled trial showed favorable changes in bone turnover markers (decreased) and calcium homeostasis; such changes in older adults have been associated with slowing of bone loss and reduced fracture risk. For example, serum CTX decreased by about 30% and PINP by about 20% as a result of the increase in calcium intake. There were also changes in the ratio of carboxylated to undercarboxylated osteocalcin and such changes have been linked to a slowing of bone loss in older subjects. For example, the ratio increased by about 60% after 3 months as a result in the improvement in vitamin K status. Finally, there were improvements in the status of B vitamins, and such changes have been associated with reductions in homocysteine, but it is uncertain whether this would affect fracture risk. The product was generally well tolerated. This study shows the nutritional supplement holds promise for improved bone health among young Indian women.

Topics: Adult; Bone Diseases, Metabolic; Bone Remodeling; Calcium; Calcium, Dietary; Dietary Supplements; Double-Blind Method; Female; Folic Acid; Fractures, Bone; Homeostasis; Humans; India; Osteocalcin; Osteoporosis; Premenopause; Vitamin B 12; Vitamin D; Vitamin K

High plasma homocysteine (Hcy) levels are associated with increased osteoporotic fracture incidence. However, the mechanism remains unclear. We investigated the effect of Hcy-lowering vitamin B12 and folic acid treatment on bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) parameters. This randomized, double-blind, placebo-controlled trial included participants aged ≥65 years with plasma Hcy levels between 12 and 50 µmol/L. The intervention comprised 2-year supplementation with either a combination of 500 µg B12, 400 µg folic acid, and 600 IU vitamin D or placebo with 600 IU vitamin D only. In total, 1111 participants underwent repeated dual-energy X-ray assessment and 1165 participants underwent QUS. Femoral neck (FN) BMD, lumbar spine (LS) BMD, calcaneal broadband ultrasound attenuation (BUA), and calcaneal speed of sound (SOS) were assessed. After 2 years, FN-BMD and BUA had significantly decreased, while LS-BMD significantly increased (all p < 0.01) and SOS did not change in either treatment arm. No statistically significant differences between the intervention and placebo group were present for FN-BMD (p = 0.24), LS-BMD (p = 0.16), SOS (p = 0.67), and BUA (p = 0.96). However, exploratory subgroup analyses revealed a small positive effect of the intervention on BUA at follow-up among compliant persons >80 years (estimated marginal mean 64.4 dB/MHz for the intervention group and 61.0 dB/MHz for the placebo group, p = 0.04 for difference). In conclusion, this study showed no overall effect of treatment with vitamin B12 and folic acid on BMD or QUS parameters in elderly, mildly hyperhomocysteinemic persons, but suggests a small beneficial effect on BUA in persons >80 years who were compliant in taking the supplement.

Topics: Absorptiometry, Photon; Aged; Aged, 80 and over; Bone Density; Calcaneus; Dietary Supplements; Double-Blind Method; Female; Femur Neck; Folic Acid; Homocysteine; Humans; Male; Osteoporosis; Ultrasonography; Vitamin B 12

Osteoporosis is a major health problem, and the economic burden is expected to rise due to an increase in life expectancy throughout the world. Current observational evidence suggests that an elevated homocysteine concentration and poor vitamin B12 and folate status are associated with an increased fracture risk. As vitamin B12 and folate intake and status play a large role in homocysteine metabolism, it is hypothesized that supplementation with these B-vitamins will reduce fracture incidence in elderly people with an elevated homocysteine concentration.. The B-PROOF (B-Vitamins for the PRevention Of Osteoporotic Fractures) study is a randomized double-blind placebo-controlled trial. The intervention comprises a period of two years, and includes 2919 subjects, aged 65 years and older, independently living or institutionalized, with an elevated homocysteine concentration (≥ 12 μmol/L). One group receives daily a tablet with 500 μg vitamin B12 and 400 μg folic acid and the other group receives a placebo tablet. In both tablets 15 μg (600 IU) vitamin D is included. The primary outcome of the study is osteoporotic fractures. Measurements are performed at baseline and after two years and cover bone health i.e. bone mineral density and bone turnover markers, physical performance and physical activity including falls, nutritional intake and status, cognitive function, depression, genetics and quality of life. This large multi-center project is carried out by a consortium from the Erasmus MC (Rotterdam, the Netherlands), VUmc (Amsterdam, the Netherlands) and Wageningen University, (Wageningen, the Netherlands), the latter acting as coordinator.. To our best knowledge, the B-PROOF study is the first intervention study in which the effect of vitamin B12 and folic acid supplementation on osteoporotic fractures is studied in a general elderly population. We expect the first longitudinal results of the B-PROOF intervention in the second semester of 2013. The results of this intervention will provide evidence on the efficacy of vitamin B12 and folate supplementation in the prevention of osteoporotic fractures.. The B-PROOF study is registered with the Netherlands Trial (NTR NTR1333) and with ClinicalTrials.gov (NCT00696514).

Topics: Aged; Aged, 80 and over; Dietary Supplements; Double-Blind Method; Female; Folic Acid; Fractures, Bone; Humans; Incidence; Male; Osteoporosis; Treatment Outcome; Vitamin B 12

Homocysteine and related factors were evaluated as risk factors for subsequent hip fractures among 4766 elderly men and women. High levels of homocysteine and low levels of folate predicted fracture, whereas vitamin B12 and genotypes were not related to fracture risk. High homocysteine may be a modifiable risk factor for hip fracture.. Elevated plasma total homocysteine (tHcy) and deficiencies of folate and vitamin B12 are associated with risk of osteoporosis and fracture. We examined whether plasma levels of tHcy, folate, and vitamin B12 and the methylenetetrahydrofolate reductase (MTHFR) 677C-->T and 1298C-->T polymorphisms predicted hip fracture.. This was a population-based prospective study of 2639 women and 2127 men who were 65-67 yr at enrollment in 1992-1993. Information on hip fracture was obtained from computerized records of discharge diagnoses from all hospitalizations in the region in the period between enrollment and November 30, 2005. Cox proportional hazard regression was used to estimate fracture risk according to levels of plasma tHcy, folate, and vitamin B12 and for different genotypes.. Over a median follow-up period of 12.6 yr, hip fracture was recorded in 184 (7.0%) women and 90 (4.2%) men. The adjusted hazard ratio (95% CI) for fracture in subjects with high (>or=15 microM) compared with low levels (<9.0 microM) of tHcy was 2.42 (1.43-4.09) among women and 1.37 (0.63-2.98) among men. Dose-response analyses indicated a positive association between plasma tHcy and risk of fracture in both sexes and a negative association between plasma folate and risk of fracture among women only. Plasma vitamin B12 level or MTHFR genotype was not significantly related to risk of fracture after adjustments for confounding factors. The association between tHcy and risk of hip fracture was only slightly weakened by adjustments for plasma levels of vitamin B12 and folate.. tHcy seems to be a predictor for hip fracture among elderly men and women. Folate was a predictor among women only, whereas vitamin B12 and MTHFR genotype did not predict hip fracture. Our data corroborate the hypothesis that homocysteine may play a role in the pathogenesis of osteoporotic fractures.

Topics: Adult; Aged; Biomarkers; Female; Folic Acid; Follow-Up Studies; Hip Fractures; Homocysteine; Humans; Male; Middle Aged; Osteoporosis; Oxidoreductases Acting on CH-NH Group Donors; Polymorphism, Single Nucleotide; Predictive Value of Tests; Prospective Studies; Risk Factors; Vitamin B 12

Hyperhomocysteinemia is a new risk factor for osteoporosis. This study analyzed the effect of a homocysteine (HCY)-lowering treatment in osteoporotic individuals.. Osteoporotic subjects (n=47, 55-82 years) were treated with either a combination of 2.5 mg folate, 0.5 mg vitamin B(12) and 25 mg vitamin B(6) or placebo. Bone mineral density (BMD) at lumbar spine and hip was measured at baseline and after 1 year. Urinary desoxypyridinoline cross-links (DPD) and plasma levels of tartrate resistant acid phosphatase (TRAP), C-terminal cross-links of collagen I (CTx), pro-collagen type I N-terminal peptide (PINP) and osteocalcin (OC) were measured after 0, 4, 8 and 12 months.. B-vitamin supplementation significantly reduced HCY (0 vs. 12 months: 13.6+/-4.8 vs. 8.9+/-2.4 micromol/L). Placebo treatment had no effect on HCY (0 vs. 12 months: 12.0+/-3.4 vs. 12.7+/-3.9 micromol/L). BMD, TRAP, CTx, OC and PINP did not change throughout the study in both groups. Vitamin treatment decreased urinary DPD by -13% (p<0.01) after 8 and 12 months. In a sub-group analysis of hyperhomocysteinemic subjects (HCY>15 mumol/L, n=8), B-vitamin treatment tended to increase BMD at the lumbar spine, with a t-score from -2.7 to -1.7, and to decrease OC and PINP by approximately 50%.. B-vitamin supplementation had no consistent effects on bone turnover or BMD. However, the situation may be different in patients with hyperhomocysteinemia.

Topics: Aged; Aged, 80 and over; Biomarkers; Bone Density; Bone Remodeling; Double-Blind Method; Female; Folic Acid; Homocysteine; Humans; Male; Middle Aged; Osteoporosis; Placebos; Vitamin B 12; Vitamin B Complex

Spinal fractures are common intra-articular fractures. Osteoporosis is a common and frequent disease among the elderly with a poor prognosis and a high risk of spinal fractures. However, the underlying factors for spinal fractures in patients with osteoporosis are unclear. A total of 105 patients with osteoporosis were recruited. Clinical and followed-up information was recorded. And vitamin B12, vitamin B2, vitamin A, and vitamin B9 in the blood were tested. Pearson's chi-squared and spearman tests were performed to analyze the correlation between spinal fractures and relative parameters. Univariate and multivariate logistic regression, univariate and multivariate Cox proportional hazards regression analysis. There exists strong relation between the expression level of vitamin B12 and spinal fractures. Pearson's chi-square and Spearman correlation test showed a strong association between vitamin B12 and vitamin B9 and a spinal fracture. Univariate logistic regression analysis showed that vitamin B12 and vitamin B9 were significantly associated with a spinal fracture. Multivariate logistic regression analysis showed that vitamin B12 was associated considerably with a spinal fracture. In addition, Cox regression analysis showed that vitamin B12 expression was significantly associated with maintenance time from recovery to recurrence (MTRR) of spinal fractures in patients with osteoporosis. Enhanced vitamin B12 is significantly correlated with the poor prognosis of patients with osteoporosis and the increasing incidence of a spinal fracture. The higher the vitamin B12, the higher the risk of spinal fracture and the shorter the time to spinal fracture recurrence.

Topics: Aged; Biomarkers; Folic Acid; Humans; Osteoporosis; Spinal Fractures; Vitamin B 12

As life expectancy increases, the prevalence of osteoporosis is increasing. In addition to vitamin D which is well established to have an association with osteoporosis, B vitamins, such as thiamine, folate (vitamin B9), and cobalamin (vitamin B12), could affect bone metabolism, bone quality, and fracture risk in humans by influencing homocysteine/folate metabolism. Despite the crucial role of B vitamins in bone metabolism, there are few studies regarding associations between B vitamin-related genes and osteoporosis. In this study, we investigated the genetic association of four single nucleotide polymorphisms (SNPs) within the 3'-untranslated regions of vitamin B-related genes, including

Topics: 3' Untranslated Regions; Alleles; Antigens, CD; Female; Folic Acid; Fractures, Compression; Genetic Association Studies; Genetic Predisposition to Disease; Genotype; Humans; Membrane Transport Proteins; Osteoporosis; Osteoporotic Fractures; Postmenopause; Receptors, Cell Surface; Reduced Folate Carrier Protein; Transcobalamins; Vitamin B 12; Vitamin B Complex

Patients with celiac disease (CD) are at increased risk of osteoporosis and compromised B-vitamin status. Emerging evidence supports a beneficial role of folate and the metabolically related B-vitamins in bone health in generally healthy adults, but no previous study has investigated this in CD patients. The aim of the current study was to examine the relationship of folate, vitamins B12, B6 and B2 (riboflavin), and the related metabolite homocysteine, with bone mineral density (BMD) in CD patients.. Of the 400 treated adult CD patients invited to participate, 110 responded and met the eligibility criteria for study participation. BMD was measured using dual energy X-ray absorptiometry scanning at the lumbar spine (L1-L4), femoral neck, and total hip sites. Biomarker status of the relevant B-vitamins and homocysteine, and dietary B-vitamin intakes, were measured.. The significant predictors of low BMD were increasing age (B = 0.080, p < 0.001) and decreasing weight (B = 0.072, p = 0.004), whereas no significant relationship with serum 25-hydroxyvitamin D (B = 0.093, p = 0.928) was observed. Following adjustment for these predictors, serum vitamin B12 (but no other B-vitamin biomarker) was found to be a significant determinant of BMD at the femoral neck (β = 0.416, p = 0.011) and total hip (β = 0.327, p = 0.049) in men only. No significant relationships were found between any of the B-vitamin biomarkers investigated and BMD (at any measured site) in women.. These findings add to current evidence suggesting a potential role of vitamin B12 in BMD, particularly in men, and show such a relationship for the first time in CD patients.

Topics: Absorptiometry, Photon; Adult; Aged; Biomarkers; Bone Density; Celiac Disease; Female; Folic Acid; Humans; Ireland; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Recommended Dietary Allowances; Sex Factors; Vitamin B 12; Vitamin B Complex; Vitamin D; Young Adult

Little information is available about long-term outcomes of major gastric surgery when performed very early in life and adverse consequences in growing children might be expected. In this case, gastrectomy with Roux-en-Y esophagojejunostomy was performed in early childhood. Despite stomach loss, growth velocity paralleled the third percentile for age during development. Maintained on a daily multivitamin and monthly B12 injections, no overt nutritional deficiencies were detected in adulthood. However, dual energy X-ray absorptiometry scan at age 31 revealed that the patient had abnormally low bone mineral density. This case study demonstrates that even after gastrectomy and reconstruction early in life, linear growth can be achieved. However, bone density can be adversely affected, even in the face of normal serum calcium and vitamin D levels.

Topics: Absorptiometry, Photon; Adult; Anastomosis, Roux-en-Y; Body Mass Index; Bone Density; Calcium; Dietary Supplements; Female; Follow-Up Studies; Gastrectomy; Gastritis; Humans; Infant, Newborn; Jejunum; Osteoporosis; Treatment Outcome; Vitamin B 12; Vitamin B Complex

Both maternal and offspring-derived factors contribute to lifelong growth and bone mass accrual, although the specific role of maternal deficiencies in the growth and bone mass of offspring is poorly understood. In the present study, we have shown that vitamin B12 (B12) deficiency in a murine genetic model results in severe postweaning growth retardation and osteoporosis, and the severity and time of onset of this phenotype in the offspring depends on the maternal genotype. Using integrated physiological and metabolomic analysis, we determined that B12 deficiency in the offspring decreases liver taurine production and associates with abrogation of a growth hormone/insulin-like growth factor 1 (GH/IGF1) axis. Taurine increased GH-dependent IGF1 synthesis in the liver, which subsequently enhanced osteoblast function, and in B12-deficient offspring, oral administration of taurine rescued their growth retardation and osteoporosis phenotypes. These results identify B12 as an essential vitamin that positively regulates postweaning growth and bone formation through taurine synthesis and suggests potential therapies to increase bone mass.

Topics: Animals; Bone Density; Bone Development; Female; Growth; Growth Disorders; Growth Hormone; Insulin-Like Growth Factor I; Intrinsic Factor; Liver; Male; Mice; Mice, Inbred C57BL; Mice, Knockout; Osteoporosis; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; STAT5 Transcription Factor; Taurine; Vitamin B 12; Vitamin B 12 Deficiency

Elevated homocysteine levels are a risk indicator for cardiovascular disease, fractures and cognitive decline. Previous studies indicated associations between homocysteine levels and medication use, including antihypertensive, lipid-lowering and antidiabetic medication. However, results were often contradictory and inconclusive. Our objective was to study the associations established previously in more detail by sub-classifying medication groups, and investigate the potential mediating role of vitamin B12 and folate status.. Baseline data from the B-PROOF (B-vitamins for the PRevention Of Osteoporotic Fractures) study were used. We included 2,912 participants aged ≥65 years, with homocysteine levels of 12-50 μmol/L and creatinine levels ≤150 μmol/L, for whom self-reported medication data were available. We used multivariable linear regression models and analysis of covariance to assess the association between medication use and plasma homocysteine levels, and the potential mediation by serum vitamin B12 and folate.. The mean age was 74 years (standard deviation, 6.5), 50 % were women, and median homocysteine levels were 14 µmol/L [interquartile range, 13-17 µmol/L]. Higher mean homocysteine levels were observed in users vs. non-users for diuretics (15.2 vs. 14.9, p = 0.043), high-ceiling sulphonamide diuretics (16.0 vs. 14.9, p < 0.001), medication acting via the renin-angiotensin system (15.2 vs. 14.9, p = 0.029) and metformin (15.6 vs. 15.1, p = 0.006). Non-selective β-blocker use was associated with lower mean homocysteine levels (14.4 vs. 15.0, p = 0.019). Only this association was mediated by an underlying association with vitamin B12 and folate levels.. The associations between homocysteine levels and medication use appear to be fairly modest. Our results suggest that medication use is unlikely to contribute to clinically relevant changes in plasma homocysteine levels.

Topics: Aged; Diuretics; Female; Folic Acid; Health Services for the Aged; Homocysteine; Humans; Male; Metformin; Netherlands; Osteoporosis; Population Surveillance; Vitamin B 12; Vitamin B 12 Deficiency

Changes in plasma total homocysteine (tHcy) folic acid, vitamins B12 and B6 in individuals with osteoporosis are reported to impair collagen cross-linking and contribute to low bone mineral density (BMD). There is paucity of information on these associations in osteoporotic patients at risk of bone fractures in Nigeria. The study evaluated plasma tHcy, folic acid, vitamins B12 and B6, in relation to BMD in individuals with osteoporosis.. Fifty osteoporotic patients age 57.05 +/- 1.9 years were selected and fifty non osteoporotic volunteer's age 54.8 +/- 0.9 years were included as controls. The osteoporotic group consisted of 11 males and 39 females (1:3.5) while the controls consisted of 13 males and 37 females (1:2.8) respectively. Bone mineral density, anthropometric indices plasma tHcy, folic acid, vitamins B12 and B6, were determined using standard procedures.. The results showed remarkably significant increase in plasma tHcy (p < 0.001) (180%) compared with the control value. Striking significant decreases were observed in folic acid (62%), vitamins B12 (42%), B6 (59%) and BMI p < 0.001) compared with control values. Positive correlation was obtained between vitamin B12 and BMD (r = 0.311, p < 0.05).. Significant increase in tHcy with corresponding decreases in folic acid, vitamins B12 and B6 are related to decrease in BMD in osteoporotic patients. These changes could be important risk factors for bone fracture in osteoporotic Nigerians. Supplementation with the B vitamins may be beneficial to the patients.

Topics: Body Mass Index; Bone Density; Female; Folic Acid; Homocysteine; Humans; Male; Middle Aged; Nigeria; Osteoporosis; Osteoporotic Fractures; Risk Factors; Vitamin B 12; Vitamin B 6

Elevated plasma levels of homocysteine (Hcy), known as hyperhomocysteinemia (HHcy), are associated with osteoporosis. A decrease in bone blood flow is a potential cause of compromised bone mechanical properties. Therefore, we hypothesized that HHcy decreases bone blood flow and biomechanical properties. To test this hypothesis, male Sprague-Dawley rats were treated with Hcy (0.67 g/L) in drinking water for 8 weeks. Age-matched rats served as controls. At the end of the treatment period, the rats were anesthetized. Blood samples were collected from experimental or control rats. Biochemical turnover markers (body weight, Hcy, vitamin B(12), and folate) were measured. Systolic blood pressure was measured from the right carotid artery. Tibia blood flow was measured by laser Doppler flow probe. The results indicated that Hcy levels were significantly higher in the Hcy-treated group than in control rats, whereas vitamin B(12) levels were lower in the Hcy-treated group compared with control rats. There was no significant difference in folate concentration and blood pressure in Hcy-treated versus control rats. The tibial blood flow index of the control group was significantly higher (0.78 ± 0.09 flow unit) compared with the Hcy-treated group (0.51 ± 0.09). The tibial mass was 1.1 ± 0.1 g in the control group and 0.9 ± 0.1 in the Hcy-treated group. The tibia bone density was unchanged in Hcy-treated rats. These results suggest that Hcy causes a reduction in bone blood flow, which contributes to compromised bone biomechanical properties.

Topics: Animals; Biomarkers; Biomechanical Phenomena; Blood Pressure; Bone Density; Bone Remodeling; Disease Models, Animal; Folic Acid; Homocysteine; Hyperhomocysteinemia; Laser-Doppler Flowmetry; Male; Osteoporosis; Rats; Rats, Sprague-Dawley; Regional Blood Flow; Tibia; Time Factors; Up-Regulation; Vitamin B 12

Whether or not mild hyperhomocysteinemia and low serum levels of folates or vitamin B12 are risk factors for osteoporosis in the elderly is controversial.. To investigate whether or not plasma levels of total homocysteine (tHcy) and serum levels of folates and vitamin B12 are associated with bone mineral density (BMD), we carried out a cross-sectional study on 446 post-menopausal women (mean age: 65.1+/-9.4 years), consecutively seen at the Siena Unit (Tuscany region, Central Italy) for BMD evaluation over a two-year period. BMD of the total femur, femoral neck and lumbar spine was detected by dual-energy X-ray absorptiometry.. The age-adjusted geometric mean of plasma tHcy levels (micromol/L) was 9.96+/-1.29 in women with normal BMD, 11.06+/-1.32 in those with osteopenia and 11.88+/-1.35 in those with osteoporosis (p<0.0001). On multiple linear regression analysis, adjusting for age, body mass index, folates, vitamin B12, creatinine clearance, smoking habit and alcohol intake, tHcy was negatively related to BMD of the total femur [beta estimate for log-homocysteine: -0.050 (95% CI: -0.100 to -0.001, p=0.048; R(2)=0.02)], but not of femoral neck or lumbar spine. There was no significant association between BMD and serum levels of folates and vitamin B12.. tHcy is negatively associated with BMD of the total femur. The contribution of tHcy to explain the variance of BMD is small (2% of the total variance) but clinically relevant, considering the high prevalence of osteoporosis among post-menopausal women and the possibility to lower tHcy by vitamin supplementation.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Body Mass Index; Bone Density; Chi-Square Distribution; Creatinine; Cross-Sectional Studies; Female; Folic Acid; Homocysteine; Humans; Italy; Linear Models; Menopause; Middle Aged; Osteoporosis; Vitamin B 12

The relationship of homocyteine, B12 and folic acid with osteoporosis has already been studied in various populations. We compared the important factors in the metabolism of homocysteine, such as homocysteine, B12 and folic acid levels, of Turkish postmenopausal women, and their relationship with the femur and lumbar spine bone mineral density.. This cross-sectional study was conducted at Gazi University, Department of Obstetrics and Gynecology. The study group consisted of 178 postmenopausal women. Serum homocysteine, folic acid and Vitamin B12 were measured. BMD was measured using DEXA at the right femoral neck and lumbar spine (L1-L4).. Upon evaluation of both the femur and lumbar spine, it was determined that osteoporosis could be associated with a homocysteine level above the median and with a B12 value under the lowest quintile value.. Plasma Hcy and vitamin B12, but not folate levels, were associated with osteoporosis. Future interventional studies are needed to determine methods to reduce Hcy levels with dietary supplements and extra vitamin B12, which will restore bone health and reduce risk of fractures.

Topics: Absorptiometry, Photon; Adult; Aged; Bone Density; Cross-Sectional Studies; Female; Femur; Folic Acid; Homocysteine; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Postmenopause; Turkey; Vitamin B 12

The risk of nutrient deficiencies increases with age in our modern Western society, and vitamin B(12) deficiency is especially prevalent in the elderly and causes increased homocysteine (Hcy) and methylmalonic acid (MMA) levels. These three factors have been recognized as risk factors for reduced bone mineral density and increased fracture risk, though mechanistic evidence is still lacking. In the present study, we investigated the influence of B(12), Hcy, and MMA on differentiation and activity of bone cells. B(12) deficiency did not affect the onset of osteoblast differentiation, maturation, matrix mineralization, or adipocyte differentiation from human mesenchymal stem cells (hMSCs). B(12) deficiency caused an increase in the secretion of Hcy and MMA into the culture medium by osteoblasts, but Hcy and MMA appeared to have no effect on hMSC osteoblast differentiation. We further studied the effect of B(12), Hcy, and MMA on the formation of multinucleated tartrate-resistant acid phosphatase-positive osteoclasts from mouse bone marrow. We observed that B(12) did not show an effect on osteoclastogenesis. However, Hcy as well as MMA were found to induce osteoclastogenesis in a dose-dependent manner. On the basis of these results, we conclude that B(12) deficiency may lead to decreased bone mass by increased osteoclast formation due to increased MMA and Hcy levels.

Topics: Animals; Bone and Bones; Bone Density; Bone Remodeling; Cell Differentiation; Cell Line; Cell Proliferation; Dose-Response Relationship, Drug; Homocysteine; Humans; Male; Methylmalonic Acid; Mice; Mice, Inbred C57BL; Osteoclasts; Osteoporosis; Up-Regulation; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Age Factors; Aged; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Diphosphonates; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Folic Acid; Humans; Male; Middle Aged; Nutritional Requirements; Osteoporosis; Practice Guidelines as Topic; Risk Factors; Vitamin B 12

Several clinical trials have reported B vitamins to be associated with osteoporosis.. Our objective was to investigate whether low serum B vitamins are associated with altered structural and biomechanical properties of human bone.. Femoral heads of 94 men and women who underwent hip arthroplasty were analyzed by using dual-energy X-ray absorptiometry (DXA), biomechanical testing (indentation method), and histomorphometry. In addition, blood was collected to measure serum concentrations of homocysteine, folate, vitamin B-6, vitamin B-12, the bone formation marker osteocalcin, and the bone resorption marker tartrate-resistant acid phosphatase (TRAP). Measurement outcomes were grouped according to subjects with high and low serum concentrations, respectively, of folate, vitamin B-6, and vitamin B-12 (n = 47 for each group).. Histomorphometric analysis showed a significantly lower trabecular thickness and trabecular area in subjects with low serum folate concentrations than in those with high serum folate concentrations and a significantly lower trabecular number in subjects with low serum vitamin B-6 concentrations than in those with high serum vitamin B-6 concentrations. In contrast, we found a comparable trabecular structure in subjects with high and low serum vitamin B-12 concentrations. DXA and biomechanical testing did not show significant differences between subjects with high and low serum B vitamin concentrations. Osteocalcin was significantly lowered in subjects with a low serum B vitamin concentration, whereas there was no association between serum B vitamins and TRAP.. The results of the present study indicate that low serum folate and vitamin B-6 concentrations, but not low serum vitamin B-12 concentrations, are associated with an altered morphology of human bone.

Topics: Absorptiometry, Photon; Aged; Arthroplasty, Replacement, Hip; Body Height; Body Weight; Bone and Bones; Bone Density; Female; Femur Head; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Osteoporosis; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

Water-soluble vitamins influence the development of an adequate structure of bone tissue, but there is scant information relating them with osteoporotic fractures. We analyze whether serum vitamin C, vitamin B12, and erythrocyte folate, or dietary intake of vitamin C and folate, are related with osteoporotic fractures in the elderly. A hospital-based case-control study was carried out at the Hospital of Jaén (167 cases, 167 controls), Spain. Cases were defined as patients aged 65 or more years with a low-energy fracture. Controls were people without fracture, matched for age and sex with cases. Diet was assessed by a semi-quantitative food frequency questionnaire. Serum vitamin C was measured using high-performance liquid chromatography (HPLC). Folic acid and vitamin B12 were measured using procedures of competitive or immunometric immunoassay. Multivariable analyses were also fitted to adjust for confounding using analysis of covariance (for the comparison of adjusted means) and conditional logistic regression (for estimating adjusted odds ratios). A statistically significant difference between cases and controls for vitamin C blood levels was found, being higher for controls (p = 0.01). Analysis of the association between serum vitamin C and fracture risk showed a linear trend (p = 0.03) with a significantly reduced risk for the upper quartile (OR = 0.31; 95% CI 0.11-0.87). The intake of vitamin C, folic acid, and B12 was not related to fracture risk, nor was there any association with erythrocyte folate or serum vitamin B12. In conclusion, serum vitamin C levels were lower in cases with osteoporotic fractures than in controls.

Topics: Aged; Aging; Ascorbic Acid; Case-Control Studies; Causality; Chromatography, High Pressure Liquid; Diet; Diet Records; Female; Folic Acid; Fractures, Bone; Geriatric Assessment; Humans; Immunoassay; Male; Multivariate Analysis; Odds Ratio; Osteoporosis; Risk Factors; Spain; Surveys and Questionnaires; Vitamin B 12

In recent years there has been increasing recognition that the pattern of presentation of coeliac disease may be changing. The classic sprue syndrome with diarrhoea and weight loss may be less common than the more subtle presentations of coeliac disease such as an isolated iron deficiency anaemia. As a result, the diagnosis of this treatable condition is often delayed or missed. Recent serologic screening tests allow non-invasive screening to identify most patients with the disease and can be applied in patients with even subtle symptoms indicative of coeliac disease. Both benign and malignant complications of coeliac disease can be avoided by early diagnosis and a strict compliance with a gluten free diet.. The aim of this study is to evaluate the trends in clinical presentation of patients diagnosed with adult coeliac disease. In addition, we studied the biochemical and serological features and the prevalence of associated conditions in patients with adult coeliac disease.. This is an observational, retrospective, cross-sectional review of the medical notes of 32 adult patients attending the specialist coeliac clinic in a district general hospital.. Anaemia was the most common mode of presentation accounting for 66% of patients. Less than half of the patients had any of the classical symptoms of coeliac disease and 25% had none of the classical symptoms at presentation. Anti-gliadin antibodies, anti-endomysial antibody and anti-tissue transglutaminase showed 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive as screening tests for adult coeliac disease. Fifty nine percent patients had either osteoporosis or osteopenia. There were no malignant complications observed during the follow up of our patients.. Most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom. Only a minority of adult coeliac disease patients present with classical mal-absorption symptoms of diarrhoea and weight loss. Patients with atypical form of disease often present initially to hospital specialists other than a gastro-enterologist. An awareness of the broad spectrum of presentations of adult coeliac disease, among doctors both in primary care and by the various hospital specialists in secondary care, is necessary to avoid delays in diagnosis. It is important to include serological screening tests for coeliac disease systematically in the evaluation of adult patients with unexplained iron deficiency anaemia or unexplained gastro-intestinal symptoms and in those who are considered to be at increased risk for coeliac disease.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Autoantibodies; Bone Density; Celiac Disease; Cross-Sectional Studies; Erythrocyte Indices; Female; Ferritins; Folic Acid; Gliadin; Humans; Intestine, Small; Male; Middle Aged; Muscle Fibers, Skeletal; Osteoporosis; Retrospective Studies; Rural Population; Skin Diseases; Transglutaminases; Vitamin B 12

Vitamin B12 is important to DNA synthesis and may affect bone formation. We examined the association between this vitamin and BMD in 2576 adults. Men with plasma B12 < 148 pM had significantly lower BMD at the hip, and women at the spine, relative to those with higher B12, and trends were similar for both at all sites. Low vitamin B12 may be a risk factor for low BMD.. Vitamin B12 is important to DNA synthesis and may affect bone formation. It has been linked to osteoblastic activity in clinical studies and cell culture.. We examined the relationship between plasma vitamin B12 status and BMD in 2576 adult participants in the Framingham Offspring Osteoporosis Study (1996-2001). BMD was measured by DXA at the hip and spine. Plasma vitamin B12 was measured by radioassay. Mean BMD measures were estimated for four categories of vitamin B12 concentration, based on commonly used cut-offs, using analysis of covariance, adjusted for age, BMI, physical activity score for the elderly (PASE), alcohol use, smoking status, total calcium and vitamin D intake, season of bone measurement, and for women, menopause status and current estrogen use. Further adjustment for protein intake and total homocysteine concentration was also performed.. Both men and women with vitamin B12 concentrations <148 pM had lower average BMD than those with vitamin B12 above this cut-off. These differences were significant (p < 0.05) for men at most hip sites and for women at the spine. Significance remained after further adjustment for protein intake and plasma homocysteine.. Vitamin B12 deficiency may be an important modifiable risk factor for osteoporosis.

Topics: Aged; Bone Density; Cohort Studies; Female; Hip; Humans; Male; Middle Aged; Osteoporosis; Spine; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia may contribute to the development of osteoporosis. The relationship of Hcy and vitamin B12 with bone turnover markers, BUA, and fracture incidence was studied in 1267 subjects of the Longitudinal Aging Study Amsterdam. High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk.. Hyperhomocysteinemia may contribute to the development of osteoporosis. Vitamin B12 is closely correlated to homocysteine (Hcy). The main objective of our study was to examine the association of Hcy and vitamin B12 status and the combined effect of these two with broadband ultrasound attenuation (BUA), bone turnover markers, and fracture.. Subjects were 615 men and 652 women with a mean age of 76 +/- 6.6 (SD) years of the Longitudinal Aging Study Amsterdam (LASA). At baseline (1995/1996), blood samples were taken after an overnight fast for dairy products. Plasma Hcy was measured with IMx, serum vitamin B12 with competitive immunoassay (IA) luminescence, serum osteocalcin (OC) with immunoradiometric assay (IRMA), and urinary excretion of deoxypyridinoline (DPD) with competitive IA and corrected for creatinine (Cr) concentration. CVs were 4%, 5%, 8%, and 5%, respectively. BUA was assessed in the heel bone twice in both the right and left calcaneus. Mean BUA value was calculated from these four measurements. CV was 3.4%. After baseline measurements in 1995, a 3-year prospective follow-up of fractures was carried out until 1998/1999. Subjects were grouped by using two different approaches on the basis of their vitamin B12 concentration, normal versus low (<200 pM) or lowest quartile (Q1) versus normal quartiles (Q2-Q4), and Hcy concentration, normal versus high (>15 microM) or highest quartile (Q4) versus normal quartiles (Q1-Q3). Analysis of covariance was performed to calculate mean values of BUA, OC, and DPD/Cr(urine) based on the specified categories of Hcy and vitamin B12 and adjusted for several confounders (potential confounders were age, sex, body weight, body height, current smoking [yes/no], mobility, cognition). The relative risk (RR) of any fracture was assessed with Cox regression analysis. Quartiles were used when Hcy and vitamin B12 were separately studied in their relationship with fracture incidence.. Fourteen percent of the men and 9% of the women had high Hcy (>15 microM) and low vitamin B12 (<200 pM) concentrations. Women with vitamin B12 levels <200 pM and Hcy concentrations >15 microM had lower BUA, higher DPD/Cr, and higher OC concentrations than their counterparts. In men, no differences were found between the different Hcy and vitamin B12 categories in adjusted means of BUA, OC, or DPD/Cr(urine). Twenty-eight men and 43 women sustained a fracture during the 3-year follow-up period. The adjusted RR for fractures (95% CI) for men with high Hcy and/or low vitamin B12 concentrations was 3.8 (1.2-11.6) compared with men with normal Hcy and vitamin B12 concentrations. Women with high Hcy and/or low vitamin B12 concentrations had an adjusted RR for fractures of 2.8 (1.3-5.7).. High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk.

Topics: Aged; Aged, 80 and over; Body Weight; Bone and Bones; Cohort Studies; Creatine; Female; Fractures, Bone; Homocysteine; Humans; Immunoassay; Immunoradiometric Assay; Male; Middle Aged; Osteocalcin; Osteoporosis; Proportional Hazards Models; Regression Analysis; Risk; Risk Factors; Time Factors; Ultrasonography; Vitamin B 12

Recent studies have found a connection between hyperhomocysteinemia and hip fracture. If this association is causal, it could be mediated through detrimental effects of low B-vitamin status on bone mineral density (BMD). Studies have linked homocysteine (Hcy) and the established Hcy determinants folate and vitamin B12, to BMD, but results have been inconsistent. Furthermore, only one study considered the specific marker of tissue vitamin B12 status, methylmalonic acid (MMA), and none have considered red blood cell (RBC) folate. To further explore associations between Hcy and B-vitamin status indicators and bone health, we used data collected on older (i.e., aged >55 years) men and women who underwent DEXA scans of the hip as participants in phase 2 of the third U.S. National Health and Nutrition Examination Survey (n = 1550). We used BMD at the total hip as a continuous outcome variable in some analyses. In others, we used osteoporosis defined on a sex- and race/ethnicity-specific basis according to World Health Organization (WHO) guidelines. After adjusting for demographic factors, body mass index, and other osteoporosis risk factors, BMD decreased and osteoporosis increased significantly with increasing serum MMA quartile category (P < 0.01). Serum vitamin B12 was related to BMD in dose-response fashion up to about 200 pmol/L, and subjects with serum Hcy > or = 20 micromol/L had significantly lower BMD than subjects with serum Hcy < 10 micromol/L. Furthermore, the OR (95% CI) relating a serum vitamin B12 concentration below the 25th percentile to osteoporosis/osteopenia was 2.0 (1.0-3.9), and dose-response trends relating both serum B12 and Hcy to this outcome were marginally statistically significant. Neither serum nor RBC folate was related to BMD or osteoporosis. We conclude that Hcy and vitamin B12 status indicators are associated with BMD in older Americans. Whether this association reflects a causal relation remains unclear and merits further study in light of age-related declines in B12 status and BMD, and the need for low-risk, easily implemented strategies for osteoporosis prevention.

Topics: Aged; Bone Density; Female; Folic Acid; Hip; Homocysteine; Humans; Male; Methylmalonic Acid; Osteoporosis; Radiography; United States; Vitamin B 12

Pronounced osteoporosis was discovered in a 44-year-old man presenting with an herniated intervertebral disk. He reported severe myopia, incomplete dislocation of the lenses and retinal detachment. He did not know of any thrombembolic events in the past. On physical examination Marfan-like appearance and a funnel chest were noted. Because of these findings Marfan syndrome was suspected.. Considering the findings of the x-rays, homocystinuria was suspected as a cause of osteoporosis, despite apparently normal cognitive functions. This diagnosis was confirmed by greatly increased values of serum homocysteine and a positive test for urinary homocystine. Since methionine and homocystine were both elevated, the diagnosis of cystathionin-beta-synthase deficiency was established.. After taking folate and vitamin B6, the homocysteine level decreased moderately. Betaine and subsequently vitamin B12 were added. Homocysteine values declined markedly on this therapeutic regimen. Two years later the patient was admitted again because of atypical angina. Coronary heart disease could be excluded by coronary angiography.. Diagnosis of premature osteoporosis should prompt consideration of homocystinuria even in adults. Premature arteriosclerosis, thrombembolic diseases, dislocation of the lens and retinal detachment may give further clues.

Topics: Adult; Age Factors; Angina Pectoris; Betaine; Diagnosis, Differential; Drug Therapy, Combination; Folic Acid; Homocysteine; Homocystine; Homocystinuria; Humans; Intervertebral Disc Displacement; Lens Subluxation; Male; Marfan Syndrome; Myopia; Osteoporosis; Retinal Detachment; Vitamin B 12; Vitamin B 6; Vitamin B Complex

Subclinical vitamin B-12 deficiency is common in the elderly. Encouraged by early indications, we investigated the plasma vitamin B-12 status in association with bone mineral content (BMC) and bone mineral density (BMD) in frail elderly people. Data of 194 free-living Dutch frail elderly (143 women and 51 men) were available. BMC and BMD were measured by dual energy X-ray analysis. Biochemical analyses were performed on plasma or serum including vitamin B-12, methylmalonic acid, homocysteine, 25-hydroxy vitamin D and parathyroid hormone. Women had higher plasma vitamin B-12 (288 and 238 pmol/L, respectively) and lower plasma homocysteine levels (15.8 and 21.3 micro mol/L, respectively) than men. Of the total explained variance of BMC and BMD in women (46 and 22%, respectively), 1.3-3.1% was explained by plasma vitamin B-12, in addition to weight and height or energy intake. In men, the variance of BMC and BMD was explained by weight, smoking and/or height (total R(2) was 53 and 25%, respectively), but not by plasma vitamin B-12. Osteoporosis occurred more often among women whose vitamin B-12 status was considered marginal or deficient than in women with a normal status, i.e., the prevalence odds ratios (after adjustment for weight, age and calcium intake) (95% confidence intervals) were 4.5 (0.8;24.8) and 6.9 (1.2;39.4), respectively. These results suggest that vitamin B-12 status is associated with bone health in elderly women. Future studies on bone health should take into account a possible role of vitamin B-12 status in different populations.

Topics: Absorptiometry, Photon; Aged; Aged, 80 and over; Body Composition; Body Height; Body Weight; Bone Density; Calcium, Dietary; Female; Frail Elderly; Homocysteine; Humans; Male; Methylmalonic Acid; Netherlands; Nutritional Status; Odds Ratio; Osteoporosis; Parathyroid Hormone; Regression Analysis; Sex Characteristics; Smoking; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D

Topics: Adult; Antioxidants; Ascorbic Acid; beta Carotene; Diet; Dietary Supplements; Female; Folic Acid; Humans; Male; Middle Aged; Osteoporosis; Vitamin A; Vitamin B 12; Vitamin D; Vitamin E; Vitamins

Pernicious anemia has recently been recognized as a risk factor for osteoporosis and fractures. Although vitamin B12 is important for osteoblast function, the effect of vitamin B12 replacement in states of vitamin B12 deficiency on bone density and fracture incidence is not known. We report 2-year follow-up data from a patient with severe osteoporosis, multiple vertebral compression fractures, and pernicious anemia who exhibited a dramatic response to treatment with vitamin B12 and cyclic etidronate. Serial bone density measurements demonstrated a 15% and 17% increase in the lumbar and greater trochanter regions, respectively, and a 79% increase in the femoral neck region over the 2-year follow-up period. In addition to normalization of bone density compared with age-matched controls, no subsequent vertebral fractures were noted in the 2-year period following initiation of vitamin B12 and etidronate therapy. This case demonstrates that osteoporosis associated with pernicious anemia may be markedly improved by vitamin B12 replacement and cyclic etidronate therapy.

Topics: Aged; Anemia, Pernicious; Drug Therapy, Combination; Etidronic Acid; Follow-Up Studies; Humans; Male; Osteoporosis; Spinal Cord Compression; Spinal Fractures; Vitamin B 12

A 32-year-old patient with anorexia nervosa since adolescence was admitted because of diffuse bone pain, increasing during the 2 preceding winters. She had a special aversion to dairy products and all forms of dietary fat. Low normal serum calcium and very low calciuria were noted, with a highly elevated bone fraction of alkaline phosphatase, and severe hypovitaminosis D and B12. Apart from a recent spontaneous fracture of the clavicle, Looser lines and pseudofractures were noted in a finger, fibula and malleolus. In particular, magnetic resonance imaging of the knee showed additional evidence of a pseudofracture in the femur, and medullary changes were found. Evidence for secondary hyperparathyroidism was described. Apart from the well known occurrence of osteoporosis, our case shows that osteomalacia may exceptionally occur in anorexia nervosa.

Topics: Adult; Alkaline Phosphatase; Anorexia Nervosa; Bone and Bones; Calcium; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Osteomalacia; Osteoporosis; Radionuclide Imaging; Vitamin B 12; Vitamin D

We studied 41 patients who had gastric bypass for obesity from 1974-1979. The procedure was well received by patients and most achieved adequate weight loss, but most subjects consumed inadequate diets and many developed iron and/or vitamin B12 deficiencies. Ten were anemic and 13 had been treated previously for postbypass anemia. Severely vitamin B12-deficient subjects did not respond to 50 micrograms oral vitamin B12 tablets, but those with milder deficiencies usually did. Schilling tests were usually abnormal and corrected when intrinsic factor was given. Many subjects developed manifestations compatible with osteoporosis due to inadequate calcium intake and absorption, and some also developed abnormal laboratory tests suggesting coexisting osteomalacia. Hematopoietic complications of gastric bypass can usually be prevented and are relatively easy to treat, but musculoskeletal complications may be more difficult to prevent and treat.

Topics: Adult; Anemia, Hypochromic; Body Weight; Diet; Female; Follow-Up Studies; Humans; Iron; Jejunum; Male; Middle Aged; Obesity; Osteoporosis; Postoperative Complications; Schilling Test; Stomach; Surveys and Questionnaires; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Twenty-seven cases of long-term survival after total gastrectomy were clinically evaluated. From the standpoint of general nutrition and rehabilitation, the patients appeared to be in satisfactory condition. However, hyperchromic anemia, serum vitamin B12 deficiency, and osteoporosis were noted in some patients.

Topics: Adult; Aged; Anemia; Body Weight; Bone and Bones; Gastrectomy; Humans; Japan; Middle Aged; Nutritional Physiological Phenomena; Osteoporosis; Postgastrectomy Syndromes; Postoperative Care; Radiography; Stomach Neoplasms; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Child; Cholelithiasis; Coronary Disease; Diabetes Mellitus; Diet Therapy; Diet, Diabetic; Diet, Reducing; Female; Humans; Hypertension; Male; Middle Aged; Obesity; Osteoporosis; Peptic Ulcer; Pregnancy; Ureteral Calculi; Urinary Bladder Calculi; Vitamin B 12; Vitamin B 6 Deficiency

Topics: Adult; Arthritis; Contusions; Drug Combinations; Female; Flufenamic Acid; Fractures, Bone; Humans; Joint Diseases; Male; Middle Aged; Osteoporosis; Pyridoxine; Sciatica; Spinal Injuries; Sprains and Strains; Thiamine; Vitamin B 12; Vitamins

Topics: Age Factors; Aged; Blood Proteins; Blood Sedimentation; Body Height; Body Weight; Bone and Bones; Calcium; Cholesterol; Densitometry; Diet; Diet, Vegetarian; Female; Fingers; Folic Acid; Hemoglobinometry; Humans; Leukocyte Count; Male; Middle Aged; Osteoporosis; Phosphates; Radiography; Urea; Vitamin B 12

Topics: Child; Child, Preschool; Coenzymes; Humans; Infant; Nutrition Disorders; Osteoporosis; Vitamin B 12

Topics: Age Factors; Aged; Anabolic Agents; Folic Acid; Heart Diseases; Humans; Nicotinic Acids; Osteomalacia; Osteoporosis; Pyridoxine; Vitamin B 12

Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents; Humans; Joint Diseases; Lidocaine; Middle Aged; Neuralgia; Osteoporosis; Pyridoxine; Quinolines; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Blood Protein Electrophoresis; Calcium; Drug Therapy; Geriatrics; Humans; Immunoelectrophoresis; Iron; Multiple Myeloma; Osteoporosis; Plasmacytoma; Pneumonia; Vitamin B 12; Vitamin B 12 Deficiency; Waldenstrom Macroglobulinemia

Topics: Anemia; Anemia, Aplastic; Ascorbic Acid; Bilirubin; Blood Cell Count; Blood Chemical Analysis; Blood Transfusion; Bone Marrow Examination; Child; Flavonoids; Folic Acid; Hematopoietic System; Humans; Infant; Infant, Newborn; Leukopenia; Osteoporosis; Prednisolone; Prednisone; Pyridoxine; Radiography; Riboflavin; Testosterone; Thiamine; Thrombocytopenia; Vitamin B 12

Topics: Arthritis; Corrinoids; Humans; Osteoarthritis; Osteoporosis; Vitamin B 12