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Timing matters: take oral B12 supplements at least two hours apart from any other medications, and consider sublingual lozenges or liquid formulations, which allow some absorption through the mouth lining and bypass the stomach entirely

Therapeutic response was defined as either normalization of serum alkaline phosphatase (SAP) or a reduction of at least 75% from baseline in total SAP excess at the end of 6 months

The BSH recommends that treatment decisions should be based on clinical presentation rather than borderline laboratory values alone

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