Adults aged 50 and older with vitamin B12 deficiency faced a 33 percent higher long-term risk of fractures than those with normal levels, according to a large study published in Scientific Reports. The researchers caution the findings do not prove deficiency causes fractures.

The team analyzed health records from the TriNetX Global Collaborative Network. They studied adults 50 and older who had B12 testing between 2016 and 2023, then used propensity-score matching to compare 115,735 people with deficiency against the same number with normal levels.

Deficiency was defined as 199 picograms per milliliter or lower. During follow-up, fractures occurred in 7.2 percent of the deficient group compared with 6 percent of the normal group. A sensitivity analysis covering years one through five showed a 37 percent higher hazard.

Secondary analyses also found higher risks of osteoporosis, lower-limb fractures, falls and repeated falls, with increases ranging from 22 percent for osteoporosis without fracture to 50 percent for repeated falls.

Deficiency may raise fracture risk through nerve problems, muscle weakness and unsteady gait that increase falls, as well as effects on bone cells. The authors stress their results describe an association in tested patients, not proof that B12 supplements would reduce fractures.