Can someone Interpret this article for me?

[MoKayD]

jamanetwork.com/journals/ja... This study researched high levels of B12 and B6 supplementation by post menopausal women. They found a correlation with high levels of B12 and B6 intake and hip fractures. Being a post menopausal woman I was interested to see what they found. I've read through this article several times but I'm not understanding the conclusion. I know that the term "increased" can mean just a slightly elevated chance of an occurrence. But does it mean only oral intake or would injections produce the same results. It's not like I'm going to stop my injections but I would like to understand this information.

[fbirder]

They found a correlation. That doesn't mean that large doses of B12 cause hip fractures. I can think of a possible alternative explanation.

If low levels of B12 caused osteoporosis (ncbi.nlm.nih.gov/pubmed/815... then the women taking high levels of B12 may have had osteoporosis for a long time before they were advised to take B12 supplements.

[MoKayD in reply to fbirder]

Thank you for explaining this to me! I feel better now.

[Foggyme Administrator in reply to MoKayD]

MoKayD...to add to fbirder comments...

Whilst the study speaks to a potential correlation between consuming high dose supplements of B12 and B6 and hip fractures (but no causative mechanism), their conclusion that caution should be used in B12 vitamin supplementation is aimed at the 'supplementing well' (i.e. at those who do not have B12 deficiency).

Obviously, those who are B12 deficient have no choice but to supplement...and at a frequency and level that keeps symptoms at bay.

Also - the study has 'lumped together' vitamin B12 and vitamin B6, with no apparent information about why these supplements were taken in the first place (a missing variable in the study) or what other medical 'need' may have determined a requirement for the supplements...a need which may have pre-disposed the cohorts to osteoporosis, in the first place (another missing variable).

The main selection criteria appears to be Postmenopausal women supplementing with high doses of vitamin B12 and vitamin B6. As a note of curiosity, I'd be interested to see what the results would be had they also selected a parallel cohort of similar aged and similar supplementing men😉. (Women start with lower bone density and lose bone mass more quickly as they age. So...I wonder...what would be the rate of osteoporosis and hip fracture in similarly supplementing men - would the proposed correlation hold up? No idea, but it'd be interesting to see).

So...no information about those at potential pre-existing risk from osteoporosis (and hip fracture) because of actual B12 deficiency, and no information relating to the potential for high doses of B6 as a requirement due to other underlying health conditions (i.e in kidney disease - which can result in osteoporosis, in autoimmune conditions - where medications can cause osteoporosis etc.).

So...the study (as far as I can see) does not take into account a significant number of variables that may in themselves cause a higher incident of osteoporosis. In this sense, the 'correlation' between high doses of B12 and B6 and osteoporosis is nebulous (to say the least)...and certainly far removed from any notion of causative connections.

In short...those who need B12 (and have high levels of serum B12 as a consequence of treatment for B12 deficiency)...well...need B12!

Something in the link below about the safety of B12:

stichtingb12tekort.nl/weten... (B12 Treatment Safety / Long Term Treatment for neurological symptoms)

👍

[MoKayD in reply to Foggyme]

Thank you for sharing your insightful analysis of their research.

[fbirder in reply to Foggyme]

And another possible interpretation springs to mind -

If the people taking B12 supplements were deficient, but weren't taking enough (or only taking oral supplements) - no attempt was made to determine if the women taking the supplements were actually absorbing any. Then they were being undertreated.

If they were being undertreated for a B12 deficiency then they would be more likely to have symptoms of such a deficiency - including poor balance. Which will make them more likely to fall over.

[Foggyme Administrator in reply to fbirder]

And Bob's your uncle, bang goes a hip...

And they've probably all got peripheral neuropathy from all that B6...so bang goes the other hip 🤣🤣🤣

[Miss-guineapig in reply to Foggyme]

Well that certainly put a smile on my face xx

[Foggyme Administrator in reply to Miss-guineapig]

😉👏👏👏👏👏xx

[Astridnova in reply to Foggyme]

Did they say why they had undertaken this study?

[Foggyme Administrator in reply to Astridnova]

Astridnova. This is what it says in the study:

Abstract

Importance Vitamin supplementation far exceeding recommended doses is popular in segments of the population. However, adverse effects can occur. In a previous secondary analysis of combined data from 2 double-blind randomized clinical trials (RCTs), an unexpected increased risk of hip fracture was found among those treated with high doses of vitamin B6 in combination with vitamin B12.

Objectives To study if high intakes of vitamins B6 and B12 from food and supplements were associated with a risk of hip fracture in the Nurses’ Health Study and to investigate whether combined high intakes of both vitamins conferred a particularly increased fracture risk.

All a bit woolly, to say the least. 🤦‍♀️

[wedgewood in reply to fbirder]

If the patients were getting high levels of B12 for treatment of Pernicious Anaemia, then those patients would have low/no levels of stomach acid ( caused by PA. ),which can result in poor absorption of minerals eg calcium ,leading to brittle bones . If the post-menopausal women ,were being treated for B12 deficiency ,if they didn’t have PA , one would expect that they had lower than normal stomach acid , as this happens as we age anyhow , leading to malabsorption of calcium . .It happens so often anyhow with older people - they have a not too serious fall and often it’s the hip that breaks , without having high B12 amounts . Just writing my random thoughts .

[Foggyme Administrator in reply to wedgewood]

Good thought's wedgewood...so bang goes another nothing to do with high levels of B12 hip. Ouch 😕.

[deniseinmilden in reply to Foggyme]

And from that one might conclude that taking B12 and B6 predisposes one to having 3 hips!! 😜 😁 😁 😁

Good answers and good for questioning a questionable article.

Sometime ago a science programme on Radio 4 spoke about the lack of depth and cross-questioning of a surprising number of published papers.

[Foggyme Administrator in reply to deniseinmilden]

You can never have enough hips deniseinmilden 🤣🤣

Agree...published papers need to be approached with a good dose of healthy skepticism and a very beady beady sharp pair of 👀👀

[Miss-guineapig in reply to wedgewood]

Good points though x

[Hidden]

Considering the total number of people involved in the survey and the small number of hip breaks and the wide range of variables there doesn't seem to be any really clear evidence of much, other than some women broke their hips and some of those were taking supplements. Correlation does not necessarily indicate causation.

I am minded of a survey I read when studying Statistics which had declared a range of cosmetics could be related to breast cancer in women treated in a large hospital in USA. The cosmetic company had to do further study as the report caused a dramatic reduction

In their sales. The further study showed that the proportion of the women suffering breast cancer and using the cosmetics was exactly the same as the proportion of the national population who used that range of cosmetics.

As I am well outside the target population profile as being male it isn't any sort of survey I would see as valid to me anyway. But even were it to be targeted at my grouping I wouldn't have seen anything to have been concerned about.

[fbirder in reply to Hidden]

To be fair, I think that the survey was large enough and the correlation(s) clear enough. It's just that they seem to have totally ignored any other possible reasons for there to be a correlation.

That's because a study that says 'We have found that X causes Y' is much more likely to be published (and the authors much more likely to get further funding) than a study that says 'We have found a correlation between X and Y that may be caused by A, B, C, D, or unknown factors, but we didn't test the right variables to rule them out'.

This is about as valid as finding that people who buy large sized shoes are more likely to have large hands. And then concluding that buying larger shoes causes them to have large hands.

[Hidden in reply to fbirder]

Sadly, there isn’t much to be bothered about isn’t a conclusion any journalist or newspaper is going to be interested in.

I did get involved in a couple of clinical studies by Sheffield University a few years ago and they had the terms of reference tied down very firmly. If nothing else one told me I didn’t have a problem with brittle bones, and they didn’t notice anything sinister requiring them to advise my doctors following the full body scan. 5 phials of blood taken every couple of days for 2 weeks twice was a real trial though and now my veins dive for cover whenever a phlebotomist comes near.

[Cherylclaire Forum Support in reply to Hidden]

Nothing there of use for a journalist or newspaper, but eliciting laugh-out-loud responses from Foggyme ? Priceless