According to background information in the article, stroke patients have a two to four times greater risk of hip fracture than their healthy peers. Researchers believe this may be due to higher levels of plasma homocysteine (an amino acid) in stroke patients, which may be associated with osteoporosis and the risk of a hip fracture. Homocysteine levels may be decreased by treatment with folic acid and vitamin B12.

Yoshihiro Sato, M.D., from the Mitate Hospital, Tagawa, Japan, and colleagues investigated the occurrence of hip fractures in stroke patients who were given folic acid and vitamin B12, and those who received placebo. Of patients studied, 314 received 5 mg of folate and 1500 micrograms of B12, while 314 patients received placebo. Participants were instructed to keep track of falls on a daily calendar. Five hundred fifty-nine patients completed this two-year follow-up.

The researchers recorded six hip fractures in patients who received folic acid and B12, and 27 hip fractures in the placebo group. The difference in total number of fractures over the two-year follow up was significant, with eight fractures in the treatment group and 32 in the placebo group. Patients receiving folic acid and B12 experienced a 38 percent decrease in their plasma homocysteine levels, while levels increased by 31 percent in the placebo group.

"Treatment with folate and mecobalamin [vitamin B12] was effective in reducing the risk of the serious poststroke complication of fractures. The high incidence of hip fractures in elderly patients with stroke may be attributed to frequent falls, as well as osteoporosis" the authors write. "In our study, the number of falls was similar in both groups during the follow-up period and the combined therapy with folate and [v
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Contact: Yoshihiro Sato, M.D.
y-sato@ktarn.or.jp
JAMA and Archives Journals
1-Mar-2005