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

Common causes include pernicious anaemia (autoimmune condition), plant-based diets without supplementation, gastrointestinal surgery, and long-term use of metformin or proton pump inhibitors

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

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Without blood testing, you cant confirm oral supplements are effectively raising your B12 levels

(More information) Both depression and osteoporosis have been linked to diminished vitamin B 12 status and high homocysteine levels