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August 17, 2005

Folate and Vitamin B

JAMA. 2005;294(7):792. doi:10.1001/jama.294.7.792-a

To the Editor: Dr Sato and colleagues1 reported the first evidence that treatment of elderly patients with hemiplegia following stroke and high levels of plasma homocysteine, using folate and mecobalamin (vitamin B12), decreases plasma homocysteine levels and markedly reduces the risk of hip fracture. This treatment did not affect bone mineral density (BMD) or fall frequency in these patients, consistent with a recent epidemiological study2 that found that high homocysteine levels in blood were associated with an increased risk of nonvertebral fractures in older people independent of BMD or recent falls. These findings suggest that the reduced fracture risk results from an improvement of bone quality, possibly countering inhibition of collagen cross-linking by homocysteine.1,2 However, homocysteine levels are closely linked to vitamin B12 levels, and serum vitamin B12 levels in these patients were low at baseline and markedly increased after the treatment; therefore, vitamin B12 itself might be directly involved in the improvement of bone quality.