Stroke Survivors: Get Hip Protection

Newswire (April 28, 2005)—People who have suffered a stroke are at high risk of sustaining a hip fracture in the years after their stroke; however, supplementing with folic acid and vitamin B12 can greatly reduce the chances that stroke victims will break a hip, reports the Journal of the American Medical Association (2005;293:1082–8).

Stroke victims have a high frequency of hip fractures for a number of reasons. Because they are often weak or paralyzed on one side of their body, they are at increased risk of falling. In addition, people who have had a stroke may become housebound and therefore unable to obtain the sunlight exposure needed to manufacture bone-protecting vitamin D. Stroke patients also tend to have elevated blood levels of homocysteine (a breakdown product of the amino acid methionine), a risk factor both for cardiovascular disease and for osteoporosis and fractures.

In the current study, participants were elderly people (average age, 71 years) who had suffered a stroke at least one year prior to the study. The average homocysteine level in the participants was above normal at the start of the study. Each person was randomly assigned to receive a combination of folic acid (5 mg per day) and vitamin B12 (1,500 mcg per day, as methylcobalamin) or a placebo for two years. These vitamins have been shown to reduce homocysteine levels and might, therefore, lower the risk of osteoporosis and of further cardiovascular problems. After two years, the average homocysteine concentration decreased by 38% in the group receiving the vitamins and increased by 31% in the placebo group.

During the study, hip fractures occurred in 1.9% of participants given the vitamin supplements and in 8.6% of those receiving the placebo. Thus, supplementing with folic acid and vitamin B12 reduced the incidence of hip fractures by 78%. Based on these results, the researchers calculated that, for every stroke patient treated with folic acid and vitamin B12 for two years, one hip fracture would be prevented.

Vitamin supplementation did not seem to prevent fractures by reducing the number of falls, since the frequency of falls was similar in the vitamin and placebo groups. Earlier studies suggested that homocysteine is toxic to bones, decreasing both bone density and the quality of bone tissue. Therefore, folic acid and vitamin B12 therapy probably prevented fractures by reducing the level of homocysteine in the body.

The results of this study demonstrate that stroke victims can reduce their chances of having a hip fracture by supplementing with folic acid and vitamin B12. Other people with high homocysteine levels might also benefit from taking these vitamins. In addition to folic acid and vitamin B12, several other nutrients play a role in lowering homocysteine levels, including vitamin B6, choline, and betaine.