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The core mechanism of osteoporosis (imbalance of bone metabolism) Osteoporosis is essentially a negative balance between bone formation and bone resorption, resulting in continuous loss of bone mass, destruction of bone microstructure, increased bone fragility, and increased risk of fractures

By inhibiting NNMT, the body maintains higher NAD levels, which in turn activate SIRT1, a longevity-associated gene, which may improve mitochondrial activity, fat oxidation, insulin sensitivity, and by overall energy balance

Intramuscular hydroxocobalamin is the preferred treatment for most patients with confirmed deficiency, particularly when malabsorption is present or neurological symptoms exist

Cyanocobalamin clears faster and requires more frequent dosing, so it has largely fallen out of routine use here