الفهرس 
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Abstract
DM and osteoporosis are common disorders with an enormous health burden. These conditions can be often associated, especially in elderly individuals, with a further worsening of the morbidity and mortality of affected patients.
The metabolic changes resulting from DM considerably affect bone metabolism and increase the risk of fractures. Fracture risk is increased in patients with DM compared with normal subjects, not only in those with low BMD but also in those with normal or high BMD.
DM has been associated with low concentrations of vitamin B12, but this is controversial with some studies showing no change and others increased levels of vitamin B12. DM itself is not a direct cause of vitamin B12 deficiency, but vitamin B12 deficiency is a potential comorbidity that is often overlooked in elderly diabetics. Vitamin B12 deficiency seems to be markedly underdiagnosed.
The important role played by vitamin B12 in a broad range of organs and systems is recognized and documented. Vitamin B12 affects normal growth and development, the peripheral and central nervous systems, bone marrow, skin, mucous membranes, vessels, as well as bones. However, the previous studies of the association between vitamin B12 blood level and BMD showed diverse results.
Few studies examined the relationship between vitamin B12 and BMD in elderly diabetic patients. Therefore, the aim of this work was to study the relationship between serum level of vitamin B12 and BMD in elderly diabetic patients.
The study sample comprised ninety participants aged sixty years and above. They were divided into 3 groups:
Group A: Thirty elderly patients diagnosed to have diabetes mellitus with other comorbidity (s).
Group B: Thirty elderly diagnosed to have diabetes mellitus without any other comorbidity.
Both groups (A and B) were recruited from outpatient clinics of Ain Shams University hospital.
Group C (control group): Thirty healthy elderly subjects. They were recruited from the community.
Every study participant underwent: informed consent, comprehensive geriatric assessment, measurement of serum level of vitamin B12, and assessment of BMD by DXA.
Our study revealed that mean lumbar spine BMD, T-score and Z-score were significantly higher in female diabetic patients with comorbidities compared with female subjects in other groups. This difference was not found in left femoral neck densitometry results. There was no significant difference between males in the three groups as regards densitometry results at lumbar spine or left femoral neck.
Serum vitamin B12 level was significantly higher in diabetic patients with comorbidities compared with other groups. Deficient serum vitamin B12 status was more common in healthy subjects.
No significant difference was found between the three densitometry categories (normal, osteopenia and osteoporosis) as regards serum vitamin B12 level; neither in diabetic patients nor in healthy subjects.
Left femoral neck BMD was inversely correlated with serum vitamin B12 level in diabetic patients with comorbidities.
Dependence in ADL and IADL was more common in diabetic patients with comorbidities compared with other groups. Falls were significantly more common in diabetic patients compared with healthy subjects.
No significant relationship was found between serum vitamin B12 status in diabetic patients and the presence of peripheral neuropathy, occurrence of falls or fractures, functional status or history of treatment with metformin or acid blockers.