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Osteoporosis International

, Volume 25, Issue 1, pp 131–140 | Cite as

Low holotranscobalamin and cobalamins predict incident fractures in elderly men: the MrOS Sweden

  • C. LewerinEmail author
  • H. Nilsson-Ehle
  • S. Jacobsson
  • H. Johansson
  • V. Sundh
  • M. K. Karlsson
  • Ö. Ljunggren
  • M. Lorentzon
  • J. A. Kanis
  • U. H. Lerner
  • S. R. Cummings
  • C. Ohlsson
  • D. Mellström
Original Article

Abstract

Summary

In a population-based study on cobalamin status and incident fractures in elderly men (n = 790) with an average follow-up of 5.9 years, we found that low levels of metabolically active and total cobalamins predict incident fractures, independently of body mass index (BMI), bone mineral density (BMD), plasma total homocysteine (tHcy), and cystatin C.

Introduction

Cobalamin deficiency in elderlies may affect bone metabolism. This study aims to determine whether serum cobalamins or holotranscobalamin (holoTC; the metabolic active cobalamin) predict incident fractures in old men.

Methods

Men participating in the Gothenburg part of the population-based Osteoporotic Fractures in Men (MrOS) Sweden cohort and without ongoing vitamin B medication were included in the present study (n = 790; age range, 70–81 years).

Results

During an average follow-up of 5.9 years, 110 men sustained X-ray-verified fractures including 45 men with clinical vertebral fractures. The risk of fracture (adjusted for age, smoking, BMI, BMD, falls, prevalent fracture, tHcy, cystatin C, 25-OH-vitamin D, intake of calcium, and physical activity (fully adjusted)), increased per each standard deviation decrease in cobalamins (hazard ratio (HR), 1.38; 95 % confidence intervals (CI), 1.11–1.72) and holoTC (HR, 1.26; 95 % CI, 1.03–1.54), respectively. Men in the lowest quartile of cobalamins and holoTC (fully adjusted) had an increased risk of all fracture (cobalamins, HR = 1.67 (95 % CI, 1.06–2.62); holoTC, HR = 1.74 (95 % CI, 1.12–2.69)) compared with quartiles 2–4. No associations between folate or tHcy and incident fractures were seen.

Conclusions

We present novel data showing that low levels of holoTC and cobalamins predicting incident fracture in elderly men. This association remained after adjustment for BMI, BMD, tHcy, and cystatin C. However, any causal relationship between low cobalamin status and fractures should be explored in a prospective treatment study.

Keywords

Cobalamins Holotranscobalamin Homocysteine Fractures Men 

Notes

Acknowledgments

The research was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, and the ALF/LUA research grant in Gothenburg.

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • C. Lewerin
    • 1
    • 11
    Email author
  • H. Nilsson-Ehle
    • 1
  • S. Jacobsson
    • 2
  • H. Johansson
    • 4
  • V. Sundh
    • 7
  • M. K. Karlsson
    • 8
  • Ö. Ljunggren
    • 9
  • M. Lorentzon
    • 4
  • J. A. Kanis
    • 5
  • U. H. Lerner
    • 3
    • 6
  • S. R. Cummings
    • 10
  • C. Ohlsson
    • 3
  • D. Mellström
    • 4
  1. 1.Section of Hematology and Coagulation, Department of Internal MedicineInstitute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  2. 2.Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  3. 3.Center for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  4. 4.Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  5. 5.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  6. 6.Molecular PeriodontologyUmeå UniversityUmeåSweden
  7. 7.Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  8. 8.Department of Clinical Sciences and OrthopaedicsLund UniversityMalmöSweden
  9. 9.Department of Medical SciencesUniversity of UppsalaUppsalaSweden
  10. 10.San Francisco Coordinating CenterCalifornia Pacific Medical Center Research Institute and the University of CaliforniaSan FranciscoUSA
  11. 11.Section of Hematology and Coagulation, Department of MedicineSahlgrenska University HospitalGothenburgSweden

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