Another proposed mechanism involves the binding of homocysteine to the collagenous matrix of bone, which may modify collagen properties and reduce bone strength (reviewed in 74). Alterations of bone biomechanical properties can contribute to osteoporosis and increase the risk of fractures in the elderly. Since vitamin Bseveral is a determinant of homocysteine metabolism, it was suggested that the risk of osteoporotic fractures in older subjects might be enhanced by vitamin B12 deficiency. A meta-analysis of four observational studies, following a total of 7,475 older individuals for 3 to 16 years, found a weak association between an elevation in vitamin B12 of 50 picomoles/L in blood and a reduction in fracture risk (75). A randomized, placebo-controlled trial in 559 elderly individuals with low serum levels of folate and vitamin B12 and at increased risk of fracture evaluated the combined supplementation of very high doses of folic acid (5 mg/day) and vitamin B12 (1.5 mg/day). The two-year study found that the supplementation improved B-vitamin status, decreased homocysteine concentrations, and reduced risk of total fractures compared to placebo (76). However, a multicenter study in 5,485 subjects with cardiovascular disease or diabetes mellitus showed that daily supplementation with folic acid (2.5 mg), vitamin B12 (1 mg), and vitamin B6 (50 escort service Reno mg) lowered homocysteine concentrations but had no effect on fracture risk compared to placebo (77). Another small, randomized, double-blind trial in 93 individuals with low vitamin D status found no additional benefit of B-vitamin supplementation (50 mg/day of vitamin B6, 0.5 mg/day of folic acid, and 0.5 mg/day of vitamin B12) on markers of bone health over a one-year period beyond that associated with vitamin D and calcium supplementation. Yet, the short length of the study did not permit a conclusion on whether the lowering of homocysteine through B-vitamin supplementation could have long-term benefits on bone strength and fracture risk (78). A large intervention study conducted in older people with no preexisting conditions is under way to evaluate the effect of B-vitamin supplementation on markers of bone health and incidence of fracture; this trial might clarify whether B vitamins could have a protective effect on bone health in the elderly population (79).
Only bacteria can synthesize vitamin B12 (80). Vitamin B12 is present in animal products, such as meat, poultry, fish (including shellfish), and to a lesser extent dairy products and eggs (1). Fresh pasteurized milk contains 0.9 ?g per cup and is an important source of vitamin B12 for some vegetarians (17). Those strict vegetarians who eat no animal products (vegans) need supplemental vitamin B12 to meet their requirements. Recent analyses revealed that some plant-source foods, such as certain fermented beans and vegetables and edible algae and mushrooms, contain substantial amounts of bioactive vitamin B12 (81). Together with B-vitamin fortified food and supplements, these foods in B12 deficiency in individuals consuming vegetarian diets. Also, individuals over the age of 50 should obtain their vitamin B12 in supplements or fortified foods (e.g., fortified cereals) because of the increased likelihood of food-bound vitamin B12 malabsorption with increasing age.
Most people do not have a problem obtaining the RDA of 2.4 ?g/day of vitamin B12 in food. According to a US national survey, the average dietary intake of vitamin B12 is 5.4 ?g/day for adult men and 3.4 ?g/day for adult women. Adults over the age of 60 had an average dietary intake of 4.8 ?g/day (42). However, consumption of any type of vegetarian diet dramatically increases the prevalence of vitamin B12 deficiency in individuals across all age groups (82). Some foods with substantial amounts of vitamin B12 are listed in Table 2, along with their vitamin B12 content in micrograms (?g). For more information on the nutrient content of specific foods, search USDA’s FoodData Central.