If Your Vitamin B12 Level is Low, It Could Affect Your Bones

When you think about maintaining your bone health, taking calcium and vitamin D are probably the first things that come to mind. But there's another nutrient that deserves attention: vitamin B12. Research suggests that low B12 levels may affect your bone density, increasing your risk of osteoporosis and fractures.  

The Hidden Connection Between B12 and Bone Health  

Osteoporosis isn't just a woman's disease. Men account for about 20 percent of osteoporosis cases and often face more serious consequences. For example, men experience 30 to 50 percent mortality rates within one year of a fracture, compared to women who have a 20 percent mortality rate. Perhaps most concerning is that between 50 and 70 percent of male osteoporosis cases are secondary to another underlying condition. Vitamin B12 deficiency is emerging as one of those lesser-known risk factors, according to a study published in the Journal of Bone and Mineral Research. 

Why Men Have Lower Osteoporosis Rates (But Shouldn't Ignore the Risk)  

• Men generally develop osteoporosis less frequently than women because they:  
• Accumulate greater peak bone mass during growth  
• Develop more muscle mass during puberty  
• Don't experience the abrupt hormonal changes of menopause  
• Often have shorter life expectancies  
• Fewer men undergo bone density testing, creating an ascertainment bias  

However, these protective factors don't make men immune, especially when secondary risk factors come into play.  

Understanding Your Osteoporosis Risk Factors  

There is a wide array of osteoporosis risk factors, including ones you can control and others you can’t.    

Non-Modifiable Risk Factors  

Risk factors for osteoporosis that are beyond your control include being female (men also get osteoporosis — see below), being older than 50, being post-menopausal, having a small frame, having a family history of osteoporosis and having a personal history of fractures.  

Numerous health conditions can take a toll on your bones. Some examples are gastrointestinal diseases (inflammatory bowel disease and liver disease), endocrine disorders (hyperthyroidism and hyperparathyroidism) and hematologic conditions (vitamin B12 deficiency, multiple myeloma, hemophilia and thalassemia). Even sleep apnea may interfere with bone formation through chronic sleep deprivation.  

Certain medications can compromise your bone health. These include:  

Glucocorticoids (prednisone, cortisone, hydrocortisone, methylprednisolone) - they interfere with calcium absorption, increase bone-destroying osteoclast activity, and suppress bone-building osteoblasts  

Anticonvulsants (for epilepsy) - they enhance vitamin D metabolism and cause calcium malabsorption.  

Antigonadotropic drugs (for prostate cancer) – contribute to bone fragility.  

Modifiable Risk Factors  

Most of these risk factors are lifestyle-based. Unhealthy behaviors like a sedentary lifestyle, poor nutrition, smoking, excessive alcohol consumption and poor sleep habits promote weakening bones. Interestingly, smoking has a greater effect on bone density in middle-aged and older male smokers compared to female smokers.  

The Framingham Osteoporosis Study: A Wake-Up Call About B12  

Vitamin B12 deficiency gained serious attention as a bone health risk factor following the landmark Framingham Osteoporosis Study. Researchers examined 2,576 men and women aged 30-87, measuring their plasma vitamin B12 levels and bone mineral density using dual-energy X-ray absorptiometry (DXA).  

The study results showed that B12 levels below 148 picomoles per liter were associated with a significantly higher risk of osteoporosis. But the effect showed up differently in men and women:  

• Men showed significantly lower bone mineral density at the hip  
• Women showed significantly lower bone mineral density at the spine  

These findings remained statistically significant even after researchers adjusted for age, BMI, physical activity, alcohol use, smoking, calcium and vitamin D intake, protein intake and homocysteine levels.  

Why Does B12 Matter for Your Bones?  

Vitamin B12 plays several crucial roles in maintaining bone health.  

DNA Synthesis: B12 is essential for DNA synthesis in all cells, including bone cells. Without adequate B12, your body struggles to produce new, healthy bone tissue.  

Osteoblastic Activity: B12 is linked to osteoblast function—the cells responsible for building new bones. Low B12 may compromise your body's ability to form strong bones.  

Homocysteine Connection: Homocysteine is a chemical in your blood that helps create proteins. Vitamins B12, B6 and B9 (also known as folate) break down homocysteine to produce other chemicals that your body needs. However, when B12 levels drop, homocysteine levels rise. Elevated homocysteine has been associated with increased fracture risk and compromised bone quality. 

Protein Metabolism: B12 is involved in processing carbohydrates, proteins, and fats—all essential for overall health and bone maintenance.  

Are You at Risk for B12 Deficiency?  

B12 deficiency often goes undetected because it's not routinely checked until symptoms appear. By the time you notice signs, the deficiency may have already affected your bones. Here are some common symptoms of a B12 deficiency:  

• Fatigue and extreme tiredness  
• Muscle weakness  
• Pins and needles sensation (paresthesia)  
• Sore, red tongue  
• Mouth ulcers  
• Disturbed vision  
• Psychological problems like depression and confusion  
• Cognitive issues with memory, understanding, and judgment  
• Bone fractures (sometimes the only outward sign)  

Why Would My B12 Levels Be Low?  

What causes your vitamin B12 levels to drop? Well, a handful of variables such as:  

Following a vegetarian or vegan lifestyle. Vegans and vegetarians who don't consume animal products may not get enough B12 from their diet alone, though this is relatively uncommon.  

Drinking too much alcohol. Excessive drinking interferes with B12 absorption. For men, this means having more than two drinks per day, and for women, it’s having more than one drink per day.  

Aging. As we get older, there’s a natural decline in B12 absorption. In fact, about 30 percent of people older than 50 have impaired B12 absorption. This is because our stomachs produce less acid and the intrinsic factor protein, which are important for B12 absorption.    

Taking certain medications. Proton pump inhibitors (Prilosec, Nexium, Prevacid), H2 blockers (Tagamet, Pepcid, Zantac) and Metformin (for type 2 diabetes) affects calcium metabolism, which is needed for B12 absorption.  

Having health conditions. Conditions linked to B12 deficiency include pernicious anemia, celiac disease, type 1 diabetes, thyroid disease, chronic pancreatic disease, inflammatory bowel disease (Crohn's or ulcerative colitis) and H. pylori infection. Additionally, stomach surgery, particularly weight-loss procedures and gastrectomy, is known for impairing B12 absorption.  

3 Tips for Maintaining Your B12 Levels  

Here are a few tips to help you maintain healthy B12 levels.  

Eat B12-rich foods. Dairy products (milk, cheese and yogurt), meat, fish and poultry are good sources of B12; however, the best food source of B12 is liver. Keep in mind that many foods high in B12 are also acidic. You can balance your pH levels by adding alkaline-forming foods to your diet. Here’s more on acidic foods and their effects >>  

Consider supplementation. Supplements can be controversial, but some people with B12 do well with them. But your first step isn’t deciding which type of supplement is best for you; it’s consulting with your physician. If your physician thinks supplementation is a good approach, they may suggest:  

• Multivitamins with B-complex vitamins: Your doctor may recommend these vitamins as a preventive measure.    
• B-complex vitamins – Your doctor may prefer a B-complex vitamin over a multivitamin for prevention.  
• B-12 supplements – Doctors usually recommend this vitamin if your B12 levels are low but not severe.  
• Monthly B12 injections – Doctors prescribe injections for people with conditions that lead to low B12 because oral supplements tend to be ineffective. Pernicious anemia is a good example of a condition that usually requires B12 injections.  

Work with your doctor. Your primary care physician can help diagnose and manage a B12 deficiency as well as identify the root cause. They can guide you in selecting foods that support B12 levels and bone health, monitor your B12 levels, help you stay current on bone density screenings and educate you on preventing osteoporosis.  

As an MDVIP-affiliated physician, I have time to partner with my patients. That starts with the MDVIP Wellness Program, a comprehensive battery of advanced screenings and tests that are not covered by insurance. The program helps me assess your individual risk factors, rule out underlying medical causes, and develop a personalized plan that's safe and effective for your situation. 

If you don’t have a primary care physician, consider joining an MDVIP-affiliated practice. MDVIP-affiliated physicians have more time to help you in your pursuit of a healthier lifestyle. Find a physician near you and begin your partnership in health»