Supplementation with Folic Acid and Vitamin B12 May Help Reduce the Risk of Hip Fractures

Category: Conditions of the Bone

A Japanese study compared the rate of fractures in elderly individuals who had suffered a stroke. It found that supplementation with folic acid and vitamin B12 reduced the rate of all types of fractures, and in particular, hip fractures. The study was published in the March 2005 issue of JAMA.

The study had 559 participants that were separated out into a treatment group and a control group. The participants were over 65, had a history of an ischemic stroke, and had no previous fractures. The treatment group received a daily dose of 5mg of folic acid and 1500mcg of mecobalamin (Vitamin B12). The groups were observed for 2 years and study parameters included measurements of bone mineral density (BMD), rate of fracture, rate of hip fracture, and number of falls.

It is understood that individuals who suffer stroke have a 2-4 times higher rate of hip fracture due to falls in the years after the stroke. It has also been found in previous studies that individuals who have a high level of homocystiene in their serum are more likely to have ischemic strokes and hip fracture due to low bone mineral density. Homocysteine is believed to accumulate in the serum of individuals who have low serum folic acid and Vitamin B12. Both folic acid and Vitamin B12 are necessary for the conversion of homocysteine to methionine in the blood.

The study found that the rate of fracture was much higher in the control group compared to the individuals who were taking the folic acid and Vitamin B12. Overall there were 8 fractures in the treatment group and 32 in the placebo group. There were 6 hip fractures in the treatment group and 27 in the placebo group. Homocysteine levels also decreased significantly in the serum of those in the treatment group, while the levels rose in the control group. There was no statistical difference in the change of bone mineral density between the two groups. The number of falls was not statistically different between the two groups either.

The study concluded that treatment with folic acid and Vitamin B12 was effective at reducing the risk of post-stroke fractures. This effect has serous implications for morbidity and mortality associated with stroke and hip fracture.

There were several shortcomings to the study; because there was not a statistical difference between the BMD of the two groups, a plausible mechanism of protection from fracture is not fully understood. It was originally thought that homocysteine in the blood may have a negative effect on collagen cross-linking in the bony matrix, resulting in weakness. Further studies should evaluate the effect on collagen cross linking and bone mineral density due to supplementation with folic acid and Vitamin B12. In addition, this study was performed on a specific population - Japanese subjects. This particular group has a higher percentage of fracture and an average lower BMD compared to other populations, so future studies should evaluate the effectiveness in different populations.

Posted by on November 23, 2008 10:00 AM