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

Osteoporosis International volume 25, pages 131–140 (2014)Cite this 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.

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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.

Author information

Authors and Affiliations

  1. Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of Gothenburg, Gothenburg, Sweden

    C. Lewerin & H. Nilsson-Ehle

  2. Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    S. Jacobsson

  3. Center for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    U. H. Lerner & C. Ohlsson

  4. Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    H. Johansson, M. Lorentzon & D. Mellström

  5. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J. A. Kanis

  6. Molecular Periodontology, Umeå University, Umeå, Sweden

    U. H. Lerner

  7. Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    V. Sundh

  8. Department of Clinical Sciences and Orthopaedics, Lund University, Malmö, Sweden

    M. K. Karlsson

  9. Department of Medical Sciences, University of Uppsala, Uppsala, Sweden

    Ö. Ljunggren

  10. San Francisco Coordinating Center, California Pacific Medical Center Research Institute and the University of California, San Francisco, CA, USA

    S. R. Cummings

  11. Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Bruna Stråket 5, 413 45, Gothenburg, Sweden

    C. Lewerin

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  1. C. Lewerin
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Correspondence to C. Lewerin.

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Lewerin, C., Nilsson-Ehle, H., Jacobsson, S. et al. Low holotranscobalamin and cobalamins predict incident fractures in elderly men: the MrOS Sweden. Osteoporos Int 25, 131–140 (2014). https://doi.org/10.1007/s00198-013-2527-y

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