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Cyanocobalamin taken sublingually still requires conversion after absorption

Am J Physiol 260:E846E851 Boonen S, Rosen C, Bouillon R et al (2002) Musculoskeletal effects of the recombinant human IGF-I/IGF binding protein-3 complex in osteoporotic patients with proximal femoral fracture: a double-blind, placebo-controlled pilot study

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Those most at risk include vegans, vegetarians, seniors, and people with digestive conditions that affect nutrient absorption