To the Editor: Based on their study combining registry data of serum B12 measurements and prescriptions of B12 injections, Silverstein and colleagues1 recently claimed that 64% of elderly patients receive inappropriate B12 injection treatment. Their article presents a general misconception of B12 deficiency and its treatment. The study included 146 850 patients with a prescription of B12 injections; B12 deficiency was defined as serum B12 221 pmol/L or less, but the authors fail to acknowledge the well-documented limitations in the use of this biomarker for diagnosing B12 deficiency.2,3
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Arendt JFH, Nexo E. Vitamin B12 Therapy in Older Adults and Misconception of Its Inappropriateness. JAMA Intern Med. 2019;179(11):1605. doi:10.1001/jamainternmed.2019.4899
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