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14 Important differential diagnoses to consider include medication side effects (eg, methotrexate, chemotherapy, or antibiotics such as trimethoprim), and malabsorption due to an anatomic or autoimmune cause (pernicious anemia), as well as a primary bone marrow pathology such as myelodysplastic syndrome

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Its also been speculated that oral methylcobalamin or injected hydroxycobalamin may be preferable in smokers, but that hasnt been conrmed

The Molecular Mechanism of Nitrogen-Containing Bisphosphonates as Antiosteoporosis Drugs