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For absorption-related deficiency (pernicious anaemia, post-bariatric surgery, Crohns disease) injections are necessary because the gut cannot absorb oral B12 regardless of dose

Medications including metformin, proton pump inhibitors, and H2-receptor antagonists may reduce absorption of B12, potentially prolonging the time to clinical improvement

Its a precursor to methylcobalamin and often recommended in conditions where B12 cannot be properly absorbed in the gut

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Note, though, that only the combined high intake of vitamins B6 (35 mg/day) and B12 (20 mcg/day) was associated with an increased hip fracture risk