Preventing Malnutrition to Reduce Fracture Risk in Aged Care Residents. A Dairy-Based Protein, Calcium, and Vitamin D Supplement Reduce Falls and Femoral Neck Bone Loss in Aged Care Residents: A Cluster Randomized Trial
Falls and fracture rates are high in ambulatory aged care residents, and malnutrition may contribute to falls and fracture risk by influencing bone’s material composition and structure. We aimed to test if a dairy-based protein (10 g/day), calcium (600 mg/day), and vitamin D (960 IU/day) supplement formulated to increase intakes to recommended levels would reduce falls and fracture risk in ambulatory low-level aged care residents.
This was a cluster-randomized, single-blind intervention involving 813 residents (mean age 86.1 ± 5.9 years, 76 % female) from 16 low-level aged care facilities in Melbourne, Australia. Twelve months of observation in all facilities was followed by 8 months of food-based supplementation (intervention) or usual intake (controls). Number of fallers and non-vertebral fractures was assessed in all residents, and serum 25(OH)D, PTH, osteocalcin, bone mineral density (BMD) by densitometry, bone structure and volumetric BMD at the distal radius and tibia using high-resolution pQCT, balance (Lord’s balance test), and functionality (timed up and go, walking velocity) were tested in a subset of 84 residents. Repeated measures ANOVA and logistic regression models were used to compare cases and controls.
Among the whole sample, supplementation reduced the number of fallers by 42 % (OR = 0.58, 95 % CI: 0.44–0.78, p < 0.001). Among the 58 of 84 participants with follow-up data, supplementation slowed bone loss at the proximal femur, maintained serum 25(OH)D, and reduced PTH by 16 ± 8 %, p < 0.03.
Fortifying foods with protein, calcium, and vitamin D reduced falls in ambulatory aged care residents and is an accessible and inexpensive approach to reduce falls and slow the progression of bone fragility in the elderly.
Aged care Bone loss Calcium Dairy supplementation Elderly Falls Fractures • Protein Vitamin D
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Thanks to the research team: nurses Sheila Matthews, Judy Tan, and Kylie King; technicians Alison Evans and Ali GhasemZadeh; staff Xiao Fang Wang and Qingju Wang; collaborator Julie Woods; department head Ego Seeman; and the staff and residents of the participating care facilities. Funding support was provided by Dairy Australia and the Gardiner Foundation.
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