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Effect of B vitamin (folate, B6, and B12) supplementation on osteoporotic fracture and bone turnover markers: a meta-analysis.

Ruan J, Gong X, Kong J, Wang H, Zheng X, Chen T - Med. Sci. Monit. (2015)

Bottom Line: Based on the results of 4 RCTs, this meta-analysis failed to identify a risk-reducing effect of daily supplementation of B vitamins on osteoporotic fracture in patients with vascular disease and with relatively normal plasma Hcy.In addition, we also did not find any positive effects of B vitamin supplementation on bone turnover.However, the possible benefits in selective populations, such as populations with very high plasma Hcy and from regions without B vitamin fortification should be explored in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Taizhou Municpal Hospital, Taizhou, Zhejiang, China (mainland).

ABSTRACT

Background: B vitamins (including folate, B6, and B12) supplementation can effectively and easily modify high plasma homocysteine (Hcy). However, the role of Hcy in the pathogenesis of osteoporotic fracture and bone turnover is still controversial. This meta-analysis aimed to assess the impact of B vitamin supplementation on occurrence of any osteoporotic fracture and bone turnover by pooling the results of previous studies.

Material and methods: Relevant randomized controlled trials (RCTs) were searched in databases. Data integration and analysis were done by using Review Manager 5.3 (the Cochrane Collaboration). The risk ratio (RR) and corresponding 95% confidence intervals (CI) of fracture (intervention vs. control) were estimated. Changes in bone turnover indicators (continuous data), weighted mean difference (WMD), and corresponding 95% (CI) were pooled for estimation.

Results: Based on the results of 4 RCTs, this meta-analysis failed to identify a risk-reducing effect of daily supplementation of B vitamins on osteoporotic fracture in patients with vascular disease and with relatively normal plasma Hcy. In addition, we also did not find any positive effects of B vitamin supplementation on bone turnover.

Conclusions: B vitamin supplementation might not be effective in preventing fracture and improving bone turnover. However, the possible benefits in selective populations, such as populations with very high plasma Hcy and from regions without B vitamin fortification should be explored in the future.

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Meta-analysis of the effect of B vitamin supplementation on fracture risk.
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f3-medscimonit-21-875: Meta-analysis of the effect of B vitamin supplementation on fracture risk.

Mentions: Four studies [15–18] involving 26 378 participants assessed B vitamin supplementation on fracture risk. Among them, 2 studies [16,18] gave patients a combination of folate, B6, and B12 and 2 studies [15,17] used a combination of folate and B6. Significant heterogeneity was observed when directly pooling the results of the 4 studies (I2=78%) (Figure 3). Excluding Sato et al. study significantly reduced the heterogeneity. In fact, compared with the remaining 3 studies, Sato et al. study population was highly selected and characterized as severe disability, unusually high fracture rate in controls (10 times higher than the national average of Japan), and very high Hcy concentrations (mean 19.9 μmol/L) [21]. Therefore, subgroup analysis was performed by stratifying plasma Hcy. Plasma Hcy>15μmol/L is usually considered as the boundary of high plasma Hcy [22]. Thus, stratification is based on this standard. Only Sato et al. reported significantly reduced fracture risk (RR: 0.25, 95%CI 0.12–0.53, p=0.0003) (Figure 3). The remaining 3 studies with 25 750 participants found no significant association between B vitamin supplementation and fracture risk (RR: 1.00, 95%CI 0.89–1.13, p=1.00) (Figure 3).


Effect of B vitamin (folate, B6, and B12) supplementation on osteoporotic fracture and bone turnover markers: a meta-analysis.

Ruan J, Gong X, Kong J, Wang H, Zheng X, Chen T - Med. Sci. Monit. (2015)

Meta-analysis of the effect of B vitamin supplementation on fracture risk.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4384513&req=5

f3-medscimonit-21-875: Meta-analysis of the effect of B vitamin supplementation on fracture risk.
Mentions: Four studies [15–18] involving 26 378 participants assessed B vitamin supplementation on fracture risk. Among them, 2 studies [16,18] gave patients a combination of folate, B6, and B12 and 2 studies [15,17] used a combination of folate and B6. Significant heterogeneity was observed when directly pooling the results of the 4 studies (I2=78%) (Figure 3). Excluding Sato et al. study significantly reduced the heterogeneity. In fact, compared with the remaining 3 studies, Sato et al. study population was highly selected and characterized as severe disability, unusually high fracture rate in controls (10 times higher than the national average of Japan), and very high Hcy concentrations (mean 19.9 μmol/L) [21]. Therefore, subgroup analysis was performed by stratifying plasma Hcy. Plasma Hcy>15μmol/L is usually considered as the boundary of high plasma Hcy [22]. Thus, stratification is based on this standard. Only Sato et al. reported significantly reduced fracture risk (RR: 0.25, 95%CI 0.12–0.53, p=0.0003) (Figure 3). The remaining 3 studies with 25 750 participants found no significant association between B vitamin supplementation and fracture risk (RR: 1.00, 95%CI 0.89–1.13, p=1.00) (Figure 3).

Bottom Line: Based on the results of 4 RCTs, this meta-analysis failed to identify a risk-reducing effect of daily supplementation of B vitamins on osteoporotic fracture in patients with vascular disease and with relatively normal plasma Hcy.In addition, we also did not find any positive effects of B vitamin supplementation on bone turnover.However, the possible benefits in selective populations, such as populations with very high plasma Hcy and from regions without B vitamin fortification should be explored in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Taizhou Municpal Hospital, Taizhou, Zhejiang, China (mainland).

ABSTRACT

Background: B vitamins (including folate, B6, and B12) supplementation can effectively and easily modify high plasma homocysteine (Hcy). However, the role of Hcy in the pathogenesis of osteoporotic fracture and bone turnover is still controversial. This meta-analysis aimed to assess the impact of B vitamin supplementation on occurrence of any osteoporotic fracture and bone turnover by pooling the results of previous studies.

Material and methods: Relevant randomized controlled trials (RCTs) were searched in databases. Data integration and analysis were done by using Review Manager 5.3 (the Cochrane Collaboration). The risk ratio (RR) and corresponding 95% confidence intervals (CI) of fracture (intervention vs. control) were estimated. Changes in bone turnover indicators (continuous data), weighted mean difference (WMD), and corresponding 95% (CI) were pooled for estimation.

Results: Based on the results of 4 RCTs, this meta-analysis failed to identify a risk-reducing effect of daily supplementation of B vitamins on osteoporotic fracture in patients with vascular disease and with relatively normal plasma Hcy. In addition, we also did not find any positive effects of B vitamin supplementation on bone turnover.

Conclusions: B vitamin supplementation might not be effective in preventing fracture and improving bone turnover. However, the possible benefits in selective populations, such as populations with very high plasma Hcy and from regions without B vitamin fortification should be explored in the future.

Show MeSH
Related in: MedlinePlus