B Vitamins Fight Thinning Bones

The results of two new studies suggest that taking folic acid and other B vitamins can substantially reduce the risk of bone fractures due to bone thinning, or osteoporosis. These studies, published in the New England Journal of Medicine (2004;350:2042–9 and 2004;350:2033–41), provide indirect evidence that B vitamins may be at least as important as calcium for preventing age-related fractures.

Osteoporosis is extremely common among postmenopausal women and, to a lesser extent, among older men. It is responsible for an estimated 1.2 million fractures per year, many of which lead to chronic pain and debility, or even to premature death. People can reduce osteoporosis risk by taking enough calcium and vitamin D and by engaging in regular weight-bearing exercise, such as walking or jogging. Other nutrients that may help prevent bone loss include magnesium, manganese, zinc, copper, boron, and vitamin K.

The new studies examined the relationship between the risk of developing fractures and blood levels of homocysteine, a breakdown product of the essential amino acid methionine. High homocysteine levels are associated with an increased risk of heart disease. In addition, homocysteine is believed to contribute to osteoporosis development because people with a rare genetic disease that causes their homocysteine levels to skyrocket develop severe osteoporosis at a young age. The body is capable of destroying homocysteine by several different biochemical pathways, each of which depends on the presence of folic acid, vitamin B6, vitamin B12, or betaine (a vitamin-like compound present in whole wheat, spinach, and some other foods).

Homocysteine blood levels were measured in 4,405 people, aged 55 years or older, who were then followed for periods up to 15 years. One of the studies assessed the risk of all osteoporosis-related fractures, while the other looked only at the risk of hip fractures. In both studies the results were similar: people with the highest homocysteine levels (75th percentile or higher) had nearly twice the risk of fractures than people with lower homocysteine levels. Based on their data, the researchers estimated that nearly one-fifth of all age-related fractures are caused by elevated homocysteine levels, making high homocysteine one of the most important known risk factors for fractures.

One of the two studies measured bone mineral density of the hip and spine and found, surprisingly, that homocysteine levels were not related to bone mineral density. In other words, homocysteine appears to impair bone health in a way that is unrelated to bone mineral density. Some researchers believe that homocysteine damages bones by interfering with the normal production of collagen, one of the main proteins that make up connective tissue. Bone contains an elaborate meshwork of collagen, which provides the structure upon which mineralization occurs. If the collagen matrix of bone is weak and unstable, then the bones may be excessively fragile and more likely to break.

Numerous studies have shown that supplementing with folic acid, vitamin B6, vitamin B12, and betaine can reduce blood levels of homocysteine. Therefore, it is plausible that increasing one’s intake of these nutrients might also prevent age-related fractures. Reducing intake of coffee can also decrease homocysteine levels.

Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.

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