B vitamins and broken bones

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Cover Meyer He, Willett WC, Fung TT, Holvik K, Festkanich D. Association of High Intakes of Vitamin B6 and B12 of food and nutritional supplements with the risk of a hip fracture in postmenopausal women in the Nurse 'Health Study. Jama network open. 2019; 2 (5): E193591. Study target to determine whether a high intake of vitamin B6 and B12 of food and nutritional supplements in the Nurses' Health Study (NHS) were associated with a risk of hip fractures and to investigate whether a combined high supply of both vitamins caused a particularly increased risk of fracture. Design of the NHS is a prospective cohort study, the data from two -year questionnaires ...
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reference

Meyer He, Willett WC, Fung TT, Holvik K, Festkanich D. Association of High Intakes of Vitamin B 6 and B 12 Jama network open . 2019; 2 (5): E193591.

Study goal

to determine whether a high intake of vitamin B and B 12 from food and nutritional supplements in the only 'Health Study (NHS) were associated with a risk of hip fractures and to investigate whether a combined high intake of both vitamins caused a particularly increased fracture risk.

draft

The NHS is a prospective cohort study that evaluates data from two -year questionnaires that were published from June 1984 to May 2014.

participant

The participants included 75,864 postmenopausal women in the United States.

The participants were all registered nurses who were enrolled at the NHS.

study parameters evaluated

With every two -year follow -up, the researchers asked for information on the hip fracture, including the date of occurrence and a description of the circumstances. They also identified hip fractures from death certificates. Hip fractures caused by cancer or "larger traumatic events" were excluded.

The researchers assessed the nutrition in 1984, 1986 and then every 4 years until 2010 with a semi -quantitative nutritional questionnaire (FFQ). The participants reported on their ordinary frequency of consumption last year for certain portion sizes of more than 130 foods. The daily energy and nutrient absorption was calculated from the overall nutrition.

The FFQ asked for information on the current use of nutritional supplements such as vitamin B 6 folic acid, vitamin B complex, vitamin B 12 -NURE DURATION SEE (from 1998), Multivitamine, vitamin A, vitamin D and calcium

All two-year follow-up questionnaires rated the following dimensions: weight; Hours a week that are spent on leisure activities; Smoke status; Menopause status and application of postmenopausal hormone therapy; Diagnoses of cancer, diabetes, cardiovascular diseases and osteoporosis; and use of thiaziddiuretics, furosemide-like diuretics and oral corticosteroids.

From 1992, the questionnaires contained questions about equilibrium disorders, for climbing stairs or on foot a block of houses and from 1998 questions about falling and pernicious anemia. In the years 1992, 1996 and 2000, questionnaires were asked about the self -assessed general state of health.

Primary result measurements

Incase hip fractures

vitamin B 6 vitamin B 12 and "other nutrient intake that have been averaged cumulatively via the follow -up".

important knowledge

The researchers analyzed data from July 2016 to June 2018. The median post -observation period was 20.9 years.

There were 2,304 fracture cases from the cohort of 74,864 women (3.04 %). The median age at the time of the hip fracture was 75.8 years (age range: 46.7–93.0 years).

These women had overall vitamin B intake and vitamin B 12 intake of 3.6 (4.8) mg/d or 12.1 (11.7) μg/d.

The physical activity increased and the prevalence of smoking decreased with a higher absorption of both vitamins. The intake of other micronutrients was also higher in those with increased absorption of vitamin B.

Compared to the Reference category Total Vitamin B less than 2 mg/d, an intake of at least 35 mg/d was connected to a statistically not significant increase in the hip fracture risk after all covariates were adapted (relative risk [RR], 1.29; 95% confidence interval [CI] 1.04–1.59; p =. 06 for linear trend).

for vitamin B 6 only from nutritional supplements, those who do not consume vitamin B 6 dietary supplements had the lowest risk compared to a similarly increased risk in the other groups.

Your conclusion contradicts several earlier studies that deal with the potential influence of B vitamins on the risk of fracture and found no significant interactions.

For total vitamin B 12 , recording quantities of at least 30 μg/d were associated with a not significantly increased risk of hip fractures, compared with recording quantities of less than 5 μg/d (RR, 1.25; 95 % KI, 0.98–1.58), and the risk rose linearly with increasing recording (1.01; 95 % Ki, 1.00-1.03 per 10-μg/d increase of the total recording;

The interaction stermato for the 2 vitamins for the risk of fracture was not significant.

In fully adapted models that included an adaptation for the use of nutritional supplements, there was no clear connection between vitamin B 6 solely through nutrition and hip fracture (RR, 1.03; 95 % KI, 0.91–1.16 per 1 mg/day increase only by food; p = 0.67 linear trend) or between vitamin b 12 solely by nutrition and hip fracture (RR, 1.01; 95 % KI, 0.99–1.02 per 1 μg/d increase of the recording only through food; p =. 54 for linear trend).

women with a high intake of both vitamins had a significantly increased risk of a hip fracture compared to the reference category with a low supply of both vitamins (RR, 1.47; 95 % AI, 1.15-1.89). In women in the categories with medium intake for both vitamins, the risk was not significantly increased (RR, 1.18; 95 % AI, 0.98-1.42). Few women had a low supply of one vitamin and a high supply of the other.

practice implications

This study raises fascinating questions about the practice and safety of the nutritional supplement. The authors state: "The risk was highest in women with a combined high intake of both vitamins, whereby they had an almost 50 % increased risk of hip fractures compared to women with a low intake of both vitamins. High intake was to be used to use food supplements."

Your data record, however, has many restrictions. Firstly, this was an observation study, and all information about the use of nutritional supplements was collected using questionnaires, a method that has inherent false capabilities. Secondly, as the authors stated, "correlating different nutritional supplements correlates, which makes it difficult to disguise certain associations." Thirdly, they could not determine or correct the fact that the participants started taking nutritional supplements for health reasons, which would not be surprising.

Your conclusion contradicts several earlier studies that deal with the potential influence of B vitamins on the risk of fracture and found no significant interactions.

A 2018 Meta-Analysis published in the magazine for bone and mineral research and, with the inclusion of 1,021 volunteers, no significant association of folic acid and vitamin B 12 A randomized, controlled clinical study from 2017 with 4,810 women published in Journal of Bone and Mineral Research also no significant effect of a B vitamin Splementation (folic acid 2.5 mg/d, vitamin B 50 mg/day and vitamin B 1 mg/d, Vitamin form not specified) on the risk of fracture. 2 In addition, the risk of a non-spine fracture in this study was in the randomized vitamin or placebo, similar to (hazard ratio [hr] = 1.08; 95 % CI, 0.88, 1,34), as well as the risk of hip (Mr. = 0.99; 95 % CI, 0.43, 2.29), wrist (HR = 1.30; 95 % CI, 0.80, 2.11) and other fractures (HR = 1.03). ; 95 % AI, 0.82, 1.30). They came to the conclusion that B vitamins neither reduced nor increased the risk of non-spine or spine fractures, and stated: "Overall, our results complement the growing number of evidence from randomized studies that show a minimal effect of a B vitamin supplementation on fracture risk."

In 2014, another double -blind, randomized, placebo -controlled clinical study was evaluated in the published American journal for clinical nutrition whether folic acid and vitamin B 12 A nutritional supplement can reduce fracture risk in patients with increased homocystone. women from 65 years (N = 2,919) With an increased homocysteine, the study were included. Homocystein decreased significantly in the low of treatment, but there were no differences in fractures.

There are no more recent primary studies that have only examined vitamin B 12 and B 6 for the risk of fracture, and the closest comparison is a secondary analysis of a 4-armed clinical study from 1984 in Norway. 4

The Norwegian study was originally developed to evaluate the effects of

  1. folic acid (0.8 mg/d) plus vitamin B (as cyanocobalamine, 0.4 mg/day) plus vitamin b (as pyridoxinhydrochloride, 40 mg/d),
  2. folic acid plus b b 6 alone, or
  3. placebo on morbidity and mortality in patients with pre -existing ischemic heart disease.

    4. In secondary analysis, the researchers evaluated 2 periods: for the first period, during the study, they used the data generated during the interventions and then compared them with the health records of the participants over a longer period of time (approx. 7 more years) after the clinical study ended. During the intervention, there was no clinically significant increase in the fracture risk. During a longer follow-up time (median 11.2 years from the start of the experiment), those who alone had a 42 % higher risk of hip fractures (HR 1,42; 95 % KI, 1.09-1.83) compared to those who do not have any income

    Taken together Studies on vitamin B and B 12 Easy and fracture risk are contradictory. The observation study to be tested is classified than less evidence -based compared to previous intervention studies. While this study implies that there may be an increased risk of fracture, there is little evidence of this observation from interventional studies.

  1. Garcia Lopez M, Baron Ja, Omsland TK, Sogaard AJ, Meyer He. Homocysteine-reducing treatment and the risk of fracture: secondary analysis of a randomized controlled study and an updated meta-analysis. JBMR Plus . 2018; 2 (5): 295-303.
  2. Stein Kl, Lui Ly, Christians WG, et al. Effect of a combination supplement with folic acid, vitamin B6 and vitamin B12 on the fracture risk in women: a randomized, controlled study. j bone miner res . 2017; 32 (12): 2331-2338.
  3. van Wijngaarden JP, Swart KM, Enneman AW, et al. Effect of a daily nutritional supplement with vitamin B-12 and folic acid on fracture incidence in older people with an increased homocysteine ​​concentration in the plasma: B-proof, a randomized controlled study. am j clin nutr . 2014; 100 (6): 1578-1586.
  4. Garcia Lopez M., Bonaa KH, Ebbing M. et al. B vitamins and hip fracture: secondary analyzes and extended follow-up of two large randomized controlled studies. j bone miner res . 2017; 32 (10): 1981-1989.