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Better Bones Blog
Dr. Susan E. Brown

Key vitamins for bone health — folic acid and folate — forms of the water-soluble vitamin B9

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Folic acid is another one of the B vitamins, referred to sometimes as folate (its related anion form), or simply as vitamin B9. The most notable role folate and folic acid play in bone health is in the detoxification of homocysteine, an amino acid linked with inflammation and increased fracture risk.

Anywhere from 5–50% of any given population (varying by geographic region and ethnicity) may have genetic variants that impact their ability to optimally metabolize folate and, thus, their ability to prevent homocysteine build-up, detoxify adequately, and keep inflammation at bay.

Homocysteine is a compound produced as a by-product of the metabolism of the amino acid methionine. Normally, homocysteine gets recycled as another substance or eliminated, but excess blood levels can accumulate as a result of genetic or nutritional factors. Excess homocysteine promotes both osteoporosis and atherosclerosis. The proper processing of homocysteine requires folic acid. Researchers suggest that around the time of menopause, women experience a reduced capacity to process homocysteine appropriately. It is not known whether this is a universal trait or one found only in more developed countries. Supplementing with folic acid has been found to improve this homocysteine processing problem.

Deficiency of folic acid is an extremely common problem in many parts of the world where diets of refined foods predominate. The average US intake is only about half the RDA. Women taking oral contraceptives or estrogen replacement, as well as users of alcohol and long-term users of anticonvulsant medications, are at special risk for drug-induced folic acid deficiency.

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Better Bones Blog
Dr. Susan E. Brown

Key vitamins for bone health — vitamin B6 (pyroxidine)

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Vitamin B6 is another nutrient that plays an important but indirect role in bone metabolism. Here are a few aspects of the work it does for us:

  • B6 is necessary for hydrochloric acid (HCl) production by the stomach, and HCl in turn is necessary for calcium absorption.
  • B6 is necessary for adrenal functioning. In turn, several dozen hormones are produced by the adrenal glands, several of which aid in maintaining proper mineral balance within the body.
  • B6 is also a necessary co-factor in the enzymatic cross-linking of collagen strands, which increase the strength of connective tissue.
  • B6 is a factor in the breakdown of homocysteine, which tends to increase in postmenopausal women. Homocysteine is a metabolite of the amino acid methionine, which interferes with collagen cross-linking and leads to defective bone matrix and osteoporosis. It also contributes to the development of heart disease. B6, along with folic acid, helps prevent build-up of homocysteine in the body.
  • All in all, more than 50 enzyme systems are directly dependent on vitamin B6, and many others function suboptimally without a sufficient amount of this nutrient.

Studies indicate that inadequate vitamin B6 intake is widespread among all population groups. In one study, all of 21 “normal American students” studied over a two–week period were found to be functionally deficient in B6.

One of the factors contributing to this problem is the relative instability of vitamin B6, which is destroyed by light and heat. As a result, much of it is lost in food processing, storage, and preparation. In addition, higher animal protein intake creates an increased demand for B6, as do other common B6 antagonists such as yellow dye #5 (food coloring), oral contraceptives, and certain other drugs and alcohol.

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Better Bones Blog
Dr. Susan E. Brown

Key vitamins for bone health — vitamin B12 (cobalamin)

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Because of their role in the detoxification of homocysteine, vitamins B6, B12, and folic acid have all been recently added to our list of important bone-protecting nutrients. Osteoblasts, the body’s bone-building cells, require an adequate supply of B12, or their ability to function properly will be compromised. Vitamin B12 deficiency anemia has been associated with osteoporosis, and having low serum levels of vitamin B12 has also been associated recently with frailty in older women.

Following careful analysis of the Framingham Offspring Study in 2000, Tufts nutritional epidemiologist Katherine Tucker concluded that B12 deficiency may be more widespread than previously thought, with nearly 40% of the US population “flirting” with marginal B12 status, according to the USDA website.

Vitamin B12 is not found in plants, but is abundant in animal protein. Yet vitamin B12 deficiency in the US may be largely linked not so much to inadequate meat, poultry and fish intake — the foods that supply the majority of dietary B12 — but to problems with intestinal absorption. Of interest is that researchers have found intestinal malabsorption to be a problem among the young and the old alike. The problem may lie with inadequate stomach acid, which is required to cleave the vitamin from the animal proteins to which it is tightly bound in food sources. In older folks, the problems with B12 absorption could be due to a loss of active acid-secreting cells in the stomach as we age. Tucker speculates that in younger adults, the problem could result from the overuse of antacid tablets.

B12 is also one of the few vitamins biosynthesized by the “friendly” flora in our intestines. Though production in the human intestines is not believed to occur to an extensive degree, there is still a lot for us to learn about both B12 synthesis and absorption processes, and it is safe to say that maintaining healthy gut flora is one way to encourage adequate vitamin B12 status as well as promote good bone health. After all, the B12 we get from animal sources originally derives from bacterial production (for instance in the rumen of cows).

Even so, vegetarians are strongly suggested to ensure adequate B12 intake — a high-quality daily supplement formulated to deliver the most highly bioavailable forms of key bone nutrients, such as those offered in our Better Bones programs, can be very helpful!

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