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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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Enhanced bone metabolism in vegetarians – the role of vitamin B12 deficiency

Wolfgang Herrmann1 / Rima Obeid1 / Heike Schorr1 / Ulrich Hübner1 / Jürgen Geisel1 / Marga Sand-Hill1 / Nayyar Ali2 / Markus Herrmann1, 3

1Department of Clinical Chemistry and Laboratory Medicine/Central Laboratory, University Hospital, Saarland University, Homburg/Saar, Germany

2Diagnostic Laboratory Services, Ministry of Health, Sultanate Oman

3ANZAC Research Institute, The University of Sydney, Concord Campus, Concord, Australia

Corresponding author: Prof. Dr. Wolfgang Herrmann, University Hospital, Department of Clinical Chemistry and Laboratory Medicine, Saarland University, Building 57, 66424 Homburg/Saar, Germany Phone: +496841-1630700, Fax: +496841-1630703,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 47, Issue 11, Pages 1381–1387, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2009.302, October 2009

Publication History

Published Online:


Background: Vitamin B12 deficiency and bone fractures are common in vegetarians. However, a direct relationship between vitamin B12 status and bone metabolism in vegetarians has not been tested sufficiently.

Methods: Our study included 96 vegetarians (23 German vegans, and 54 German and 19 Indian lacto-, lacto-ovo-vegetarians) and 89 omnivores (Germans and Asian-Indian immigrants in Oman). Blood concentrations of total vitamin B12, holotranscobalamin (holoTC), 25OH-vitamin D (25(OH)D), total homocysteine (tHcy), methylmalonic acid (MMA), and the bone turnover markers (BTMs) bone alkaline phosphatase (BAP), osteocalcin (OC), pro-collagen type I N-terminal peptide (PINP) and C-terminal telopeptides of collagen I (CTx) were measured.

Results: Vegetarians from both population groups exhibited significantly higher concentrations of tHcy, MMA, folate, and BAP, but lower concentrations of holoTC and cobalamin compared with omnivores from the same population. Additionally, German vegetarians had higher circulating activities of BAP as well as higher CTx, OC, and PINP compared with their omnivorous controls. HoloTC and MMA were correlated with OC, CTx and BAP. Subjects with low vitamin B12 status (holoTC ≤35 pmol/L and MMA >271 nmol/L) had significantly lower serum concentrations of 25(OH)D, but higher tHcy and the BTMs P1NP, BAP, OC, and CTx, compared with subjects with normal vitamin B12 status. Multiple regression analysis showed that the association between BTMs and markers of vitamin B12 status was independent from the association with 25(OH)D. Approximately 12%–14% of the variation in the concentration of BTMs was explained by a regression model including holoTC, MMA and 25(OH)D. The strictness of the diet was not related to the magnitude of change in BTMs.

Conclusions: Low vitamin B12 status is related to increased bone turnover in vegetarians which is independent from vitamin D status.

Clin Chem Lab Med 2009;47:1381–7.

Keywords: bone; homocysteine; osteocalcin; vegetarians; vitamin B12; vitamin D

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