Cyanocobalamin-Dependent Depression of the Serum Alkaline Phosphatase Level in Patients with Pernicious Anemia

Dommelen, C. K. V.; Klaassen, C. H. L.

doi:10.1056/nejm196409102711104

Cited by 29 publications

(10 citation statements)

References 7 publications

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“…Vitamin B 12 deficiency has been associated with low levels of markers of bone formation, including serum skeletal alkaline phosphatase and osteocalcin (4,5) . A cell culture study tested reactions of human bone marrow stromal osteoprogenitor cells (jBMSC) and UMR106 osteoblastic cells with differing vitamin B 12 concentrations.…”

Section: Discussionmentioning

confidence: 99%

Low Plasma Vitamin B12 Is Associated With Lower BMD: The Framingham Osteoporosis Study

Tucker¹,

Hannan²,

Qiao³

et al. 2005

Journal of Bone and Mineral Research

102

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Vitamin B 12 is important to DNA synthesis and may affect bone formation. We examined the association between this vitamin and BMD in 2576 adults. Men with plasma B 12 < 148 pM had significantly lower BMD at the hip, and women at the spine, relative to those with higher B 12 , and trends were similar for both at all sites. Low vitamin B 12 may be a risk factor for low BMD.Introduction: Vitamin B 12 is important to DNA synthesis and may affect bone formation. It has been linked to osteoblastic activity in clinical studies and cell culture. Materials and Methods: We examined the relationship between plasma vitamin B 12 status and BMD in 2576 adult participants in the Framingham Offspring Osteoporosis Study (1996)(1997)(1998)(1999)(2000)(2001). BMD was measured by DXA at the hip and spine. Plasma vitamin B 12 was measured by radioassay. Mean BMD measures were estimated for four categories of vitamin B 12 concentration, based on commonly used cut-offs, using analysis of covariance, adjusted for age, BMI, physical activity score for the elderly (PASE), alcohol use, smoking status, total calcium and vitamin D intake, season of bone measurement, and for women, menopause status and current estrogen use. Further adjustment for protein intake and total homocysteine concentration was also performed. Results: Both men and women with vitamin B 12 concentrations <148 pM had lower average BMD than those with vitamin B 12 above this cut-off. These differences were significant (p < 0.05) for men at most hip sites and for women at the spine. Significance remained after further adjustment for protein intake and plasma homocysteine. Conclusions: Vitamin B 12 deficiency may be an important modifiable risk factor for osteoporosis.

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Section: Discussionmentioning

confidence: 99%

Low Plasma Vitamin B12 Is Associated With Lower BMD: The Framingham Osteoporosis Study

Tucker¹,

Hannan²,

Qiao³

et al. 2005

Journal of Bone and Mineral Research

102

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“…The mechanism of cobalamin-dependent changes in bone mass was investigated in 1964 by Van Dommelen and Klaassen [27] and by Carmel et al [1].Van Dommelen and Klaassen reported that serum concentrations of total alkaline phosphatase were lower in patients with cobalamin deficiency than in matched controls; these values rose after cobalamin replenishment. Carmel et al [1] demonstrated that serum concentrations of skeletal alkaline phosphatase and osteocalcin were decreased in cobalamin-deficient patients and returned to normal after therapy with vitamin B 12 .…”

Section: Discussionmentioning

confidence: 99%

Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents

et al. 2004

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“…The serum alkaline phosphatase concentration is depressed in pro-portion to the severity of the anemia. 35,36 This patient's alkaline phosphatase concentration was not low, which is not surprising since she did not have severe anemia. Examination of the peripheral-blood smear is a sensitive test of vitamin B 12 deficiency.…”

Section: Differential Diagnosismentioning

confidence: 74%

Case 40-2000

Carpenter¹,

Patalas²

2000

N Engl J Med

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A 38-year-old woman was admitted to the hospital because of a tumor at the gastroesophageal junction.The patient had been in excellent health until six and a half weeks earlier, when she began to have a fever with a cough productive of green sputum. At about the same time, she also felt a "sticking" sensation on swallowing solid foods, even after thorough chewing; liquids were swallowed adequately. Lansoprazole was prescribed, without improvement. Two and a half weeks before admission, esophagogastroduodenoscopic examination at another hospital revealed a tumor, 7 by 4 cm, in the proximal portion of the stomach, with extension into the distal portion of the esophagus. Bougienage was performed, and on further endoscopic examination, the distal portion of the stomach and the duodenum had a normal appearance. Biopsy of the tumor disclosed a grade 3 adenocarcinoma. Computed tomographic (CT) scans of the thorax and abdomen, both obtained after the oral and intravenous administration of contrast material, and radiographs of the chest were normal.Two weeks before admission, the urine was normal. The prothrombin and partial-thromboplastin times were normal, as were the glucose, creatinine, conjugated and total bilirubin, and aspartate aminotransferase concentrations. The results of other laboratory tests are shown in Table 1. An electrocardiogram was normal.Ten days before admission, the patient was examined at this hospital. Her cough had persisted but had become nonproductive, and the bouts of fever had continued despite antibiotic therapy. The dysphagia had worsened recently, and she had lost 1.5 kg of weight. The patient had no known exposure to car-cinogens and maintained an active lifestyle. There was no history of early satiety, hematochezia, or melena. She did not drink alcohol or smoke. Her medications comprised an oral contraceptive, a sleeping medication, a multivitamin supplement, and occasionally, loratadine for "allergy." Her maternal grandmother had had breast cancer, but there was no other family history of cancer.The temperature was 37.8°C, the pulse was 84, and the respirations were 16. The blood pressure was 115/70 mm Hg.On examination the patient appeared well. No lymphadenopathy was detected. The anterior portion of the tongue appeared denuded in several areas. The lungs were clear, and the heart sounds were normal. Rectal examination showed only a hemorrhoid. A stool specimen was negative for occult blood. Neurologic examination revealed no abnormalities.The patient was admitted to the hospital, and a diagnostic procedure was performed. DIFFERENTIAL DIAGNOSISD R . C HRISTOPHER L. C ARPENTER *: How do we explain an adenocarcinoma of the stomach in a 38year-old woman? The first steps are to make certain that the diagnosis was correct and determine whether the tumor was primary or metastatic. Adenocarcinomas comprise 95 percent of gastric cancers, but occasionally, they are confused with other cancers. Lymphomas, squamous-cell carcinomas, carcinoids, and sarcomas also occur in the stomach. A gastric ly...

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Cyanocobalamin-Dependent Depression of the Serum Alkaline Phosphatase Level in Patients with Pernicious Anemia

Cited by 29 publications

References 7 publications

Low Plasma Vitamin B12 Is Associated With Lower BMD: The Framingham Osteoporosis Study

Low Plasma Vitamin B12 Is Associated With Lower BMD: The Framingham Osteoporosis Study

Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents

Case 40-2000

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