Medical Technology

Calcium, Protein Reduces Falls and Fractures in Older Adults

(Reuters Health) – Vitamin D-replete older adults in residential care have fewer falls and fractures when their diets include foods rich in calcium and protein, a randomized controlled trial found.

Researchers randomized 7,195 residents (mean age 86 years) of 60 residential care facilities in Australia to receive diets with additional milk, yogurt, cheese, and calcium supplements (30 facilities) or continue with their usual diets (30 facilities). The intervention provided total daily intake of 562 mg calcium and 12 g protein, for total daily intake of 1,142 mg calcium and 69 g protein; the control group on their usual diets had total daily intake of 700 mg calcium and 58 g protein.

After two years, there were a total of 4,302 falls and 324 fractures as well as 1,974 deaths from all causes. People in the intervention group were significantly less likely to experience fractures (hazard ratio 0.67), researchers report in The BMJ.

“The dairy intakes of these residents were below recommended levels,” said lead study author Sandra Luliano of the departments of medicine and endocrinology at the University of Melbourne in Australia.

“If someone is deficient and we improve their intakes to recommended levels then a benefit is likely, as we observed,” Luliano said by email. “If their intake of calcium and protein and dairy foods was sufficient, then we would be less likely to see a benefit.”

The added calcium and protein dietary intervention significantly reduced hip fractures (HR 0.54) and falls (HR 0.89).

However, there wasn’t a significant difference in all-cause mortality between the intervention and control groups.

Overall, there were 121 fractures, including 42 hip fractures in the dietary intervention group, compared with 203 total fractures, including 93 hip fractures, in the control group.

The dietary intervention made a statistically significant difference in reducing hip fractures and falls starting after three months.

There were 900 deaths in the dietary intervention group, compared with 1,074 in the control group, a difference that wasn’t statistically significant.

One limitation of the study is that less than half of the participants had follow-up longer than 15 months, the study team notes. Another is that dietary calcium and protein assessments were based on a subset of 716 consented participants, not the entire study population.

Even so, the findings should demonstrate for clinicians how important it is to counsel patients on adequate intake of foods – in this case dairy foods – as a means to reduce the risk of falls and fractures, Luliano said. This should be considered in addition to, and not as an alternative to, prescribing anti-osteoporotic medications as indicated, Luliano added.

“As this was a population-based approach, we achieved a mean calcium intake of >1100 mg/day, which is just above the Australian estimated average requirement for older adults, and a relative protein intake of 1.1 g per kg body weight, again we reached the Australian recommended intake.” Luliano said. “It highlights the importance of adequate nutrition and provision of foods of high nutritional quality in older adults in aged-care.”

SOURCE: The BMJ, online October 20, 2021.

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