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Consistently, the risk of bias assessment, revealed a moderate risk for the first 6 studies scoring three points, and high risk for the 4 studies scoring five points

Am Fam Physician (2004) 69(3):54856

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No trial reported on clinical signs and symptoms of vitamin B 12 deficiency, health-related quality of life, or acceptability of the treatment scheme Orally taken vitamin B 12 showed lower treatment-associated costs than intramuscular vitamin B 12 in one trial

This can lead to a shorter duration of B12 in the body, increasing the need for supplementation or injections to maintain adequate levels