Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial

BMJ. 2021 Oct 20;375:n2364. doi: 10.1136/bmj.n2364.

Abstract

Objective: To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day.

Design: Two year cluster randomised controlled trial.

Setting: 60 accredited residential aged care facilities in Australia housing predominantly ambulant residents.

Participants: 7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years).

Intervention: Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight).

Main outcome measures: Group differences in incidence of fractures, falls, and all cause mortality.

Results: Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08).

Conclusions: Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000228785.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Aged
  • Aged, 80 and over
  • Australia / epidemiology
  • Calcium, Dietary / therapeutic use*
  • Dietary Proteins / therapeutic use*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Hip Fractures / epidemiology
  • Hip Fractures / etiology
  • Hip Fractures / prevention & control*
  • Homes for the Aged
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Osteoporosis / complications
  • Osteoporosis / diet therapy*
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / etiology
  • Osteoporotic Fractures / prevention & control*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Reduction Behavior
  • Treatment Outcome

Substances

  • Calcium, Dietary
  • Dietary Proteins