Article 2
Vitamin B12 and Fracture Risk: Is the Relationship More Complex Than Deficiency Alone?
A large multicenter retrospective study published in Scientific Reports examined the relationship between vitamin B12 status and subsequent fracture risk in adults undergoing clinical B12 testing. Using electronic health records from the TriNetX Global Collaborative Network, researchers identified more than 115,000 individuals with vitamin B12 deficiency and matched them with an equal number of participants with normal B12 levels. After extensive propensity-score matching, fractures occurred in 7.2% of the B12-deficient group compared with 6.0% of those with normal levels, with the adjusted analysis showing a 33% higher fracture hazard among the deficient group. Higher risks were also observed for osteoporosis, osteoporotic fractures, lower-limb fractures, falls, and repeated falls.
Interestingly, the association was not limited to low B12 levels. Borderline and high B12 concentrations were also associated with increased fracture hazard, although less strongly, producing a non-monotonic pattern that suggests the relationship may be more complex than simple deficiency. B12 deficiency could plausibly influence fracture risk through effects on bone quality, homocysteine metabolism, muscle function, peripheral neuropathy, and gait stability; however, the study cannot establish causation. Important factors such as bone mineral density, physical activity, diet, muscle strength, vitamin D and calcium status were not fully available, and B12 levels were measured only at baseline.