Effect of Vitamin B12 and Folic Acid Supplementation on Bone Mineral Density and Quantitative Ultrasound Parameters in Older People with an Elevated Plasma Homocysteine Level: B-PROOF, a Randomized Controlled Trial

被引:34
作者
Enneman, Anke W. [1 ]
Swart, Karin M. A. [2 ,3 ]
van Wijngaarden, Janneke P. [4 ]
van Dijk, Suzanne C. [1 ]
Ham, Annelies C. [1 ]
Brouwer-Brolsma, Elske M. [4 ]
van der Zwaluw, Nikita L. [4 ]
Dhonukshe-Rutten, Rosalie A. M. [4 ]
van der Cammen, Tischa J. M. [1 ]
de Groot, Lisette C. P. G. M. [4 ]
van Meurs, Joyce [1 ]
Lips, Paul [2 ,3 ,5 ]
Uitterlinden, Andre G. [1 ]
Zillikens, M. Carola [1 ]
van Schoor, Natasja M. [2 ,3 ]
van der Velde, Nathalie [1 ,6 ]
机构
[1] Erasmus MC, Univ Med Ctr Rotterdam, Dept Internal Med, NL-3000 CA Rotterdam, Netherlands
[2] Vrije Univ Amsterdam Med Ctr, Dept Epidemiol & Biostat, NL-1081 BT Amsterdam, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, EMGO Inst Hlth & Care Res, NL-1081 BT Amsterdam, Netherlands
[4] Wageningen Univ, Div Human Nutr, NL-6700 EV Wageningen, Netherlands
[5] Vrije Univ Amsterdam Med Ctr, Dept Endocrinol, NL-1007 MB Amsterdam, Netherlands
[6] Acad Med Ctr, Geriatr Med Sect, Dept Internal Med, NL-1100 DD Amsterdam, Netherlands
关键词
DXA; QUS; Vitamin B-12; Folic acid; Homocysteine; PLACEBO-CONTROLLED TRIAL; POSTMENOPAUSAL WOMEN; FRACTURE RISK; TURNOVER MARKERS; ELDERLY-WOMEN; METAANALYSIS; ASSOCIATION; POPULATION; FOLATE; BMD;
D O I
10.1007/s00223-015-9968-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
High plasma homocysteine (Hcy) levels are associated with increased osteoporotic fracture incidence. However, the mechanism remains unclear. We investigated the effect of Hcy-lowering vitamin B-12 and folic acid treatment on bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) parameters. This randomized, double-blind, placebo-controlled trial included participants aged a parts per thousand yen65 years with plasma Hcy levels between 12 and 50 A mu mol/L. The intervention comprised 2-year supplementation with either a combination of 500 A mu g B-12, 400 A mu g folic acid, and 600 IU vitamin D or placebo with 600 IU vitamin D only. In total, 1111 participants underwent repeated dual-energy X-ray assessment and 1165 participants underwent QUS. Femoral neck (FN) BMD, lumbar spine (LS) BMD, calcaneal broadband ultrasound attenuation (BUA), and calcaneal speed of sound (SOS) were assessed. After 2 years, FN-BMD and BUA had significantly decreased, while LS-BMD significantly increased (all p < 0.01) and SOS did not change in either treatment arm. No statistically significant differences between the intervention and placebo group were present for FN-BMD (p = 0.24), LS-BMD (p = 0.16), SOS (p = 0.67), and BUA (p = 0.96). However, exploratory subgroup analyses revealed a small positive effect of the intervention on BUA at follow-up among compliant persons > 80 years (estimated marginal mean 64.4 dB/MHz for the intervention group and 61.0 dB/MHz for the placebo group, p = 0.04 for difference). In conclusion, this study showed no overall effect of treatment with vitamin B-12 and folic acid on BMD or QUS parameters in elderly, mildly hyperhomocysteinemic persons, but suggests a small beneficial effect on BUA in persons > 80 years who were compliant in taking the supplement.
引用
收藏
页码:401 / 409
页数:9
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