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Dr. Magloire and Dr. Selfridge report no financial relationships relevant to this field of study.
SUMMARY POINTS
* Based on the observation that elevated homocysteine levels are associated with an increased risk of hip fractures, researchers investigated whether B vitamins, which are known homocysteine-lowering agents, might be associated with reduced risk of hip fracture.* Vitamin B6 supplementation above the level of daily recommended doses is associated with an increased risk for hip fractures.* The combination of folic acid and vitamin B12 supplementation did not show an overall reduction in hip fracture risk in the study participants, either during the study or in the extended follow-up.* A secondary analysis demonstrated a decreased hip fracture incidence noted in women taking B12 with folate, compared to placebo; women represented only 23% of study participants.
SOURCE: Garcia Lopez M, Bønaa KH, Ebbing M, et al. B vitamins and hip fracture: Secondary analyses and extended follow-up of two large randomized controlled trials. J Bone Miner Res 2017;32:1981-1989.
Hip fractures are associated with significant healthcare costs, as well as morbidity, suffering, and mortality for patients. In an elderly frail patient, a hip fracture may precipitate a cascade of circumstances, including immobilization and hospitalization, that introduce potential for life-threatening events at worst and loss of independence and autonomy at best. Studies have demonstrated an association between elevated blood homocysteine levels and incidence of hip fracture and osteoporosis. Thus, it has been hypothesized that homocysteine-lowering agents might be beneficial in reducing hip fracture incidence.1
B vitamins, particularly B12, B6 and folate, reduce homocysteine levels through their coenzyme functions in the methionine cycle, converting homocysteine to methionine, which then becomes incorporated into DNA and RNA, leading to building of proteins and lipids. Interventional trials using a randomized, controlled design to study the relationship between B vitamins and hip fractures are difficult to implement because such an infrequent primary outcome requires a large number of study participants to attain statistical significance. Accordingly, interventional studies to date have been limited in number, hampered by confounding variables (such as dietary composition), and have been unable to show a benefit solely attributable to B supplementation; however, observational studies have shown a small inverse...