RESEARCH - Folate and vitamin B12 cut poststroke hip fracture risk

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Folate and vitamin B12 cut poststroke hip fracture risk

3/2/2005

By: Reuters Health

NEW YORK (Reuters Health), Mar 2 - Dietary supplements of folate and vitamin

B12 can reduce the incidence of hip fracture in elderly patients following

stroke, according to a Japanese study reported in the March 2nd issue of the

Journal of the American Medical Association.

The risk of hip fracture is significantly higher in stroke patients than in

other individuals of the same age, and is thought to be associated with

increased plasma homocysteine levels, lead author Dr. Yoshihiro Sato and

colleagues note. They hypothesized that treatment with folate and

mecobalamin (vitamin B12) would reduce hyperhomocysteinemia and thereby

reduce fracture risk.

Dr. Sato, of Mitate Hospital, Tagawa, and colleagues studied 628 patients

aged 65 years or more. All had residual hemiplegia at least one year after

ischemic stroke. Patients were randomly assigned to folate 5 mg and

mecobalamin 1500 µg daily or to placebos.

During two years of follow-up, there were no significant between-group

differences in the number of falls, but there were six hip fractures in the

treatment group and 27 in the control group (p < 0.001).

The relative risk after adjustment for dementia, cardiovascular events, and

subsequent stroke was 0.20. The authors estimate that 14 patients would need

to be treated to prevent one hip fracture.

Active treatment was associated with a 38% decrease in plasma homocysteine

level, whereas levels increased by 31% in the placebo group. However, bone

mineral density did not differ significantly between groups. No significant

adverse events were reported.

Although folate and mecobalamin treatment was associated with striking

decreases in fracture risk, " generalization to broader non-Japanese

populations should be performed with caution, " Dr. Sato's group notes.

Moreover, in an accompanying editorial, Drs. Joyce B. J. van Meurs and Andre

G. Uitterlinden, at Erasmus Medical Center, Rotterdam, the Netherlands,

observe that although the results support a link between circulating

homocysteine levels and fracture risk, " final proof of causality will have

to come from elucidation of the biological mechanism underlying this

relationship. "

Last Updated: 2005-03-01 16:34:45 -0400 (Reuters Health)

JAMA 2005;293:1082-1088,1121-1122.

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