Old adult population has been increasing thanks to longevity. The accompanying increased prevalences of chronic illnesses, loss of musculoskeletal mass, frailty, and bone fragility increase the risk of falls and fractures. Loss of independence increases the number of people needing full time institutionalized care, the source of around 30% of all hip fractures in the community.
These people often have calcium intakes below 700 mg daily, an amount unlikely to offset obligatory loss of calcium. They also often have protein intakes below 1 g/kg body weight/day, predisposing to loss of lean muscle mass.
There are many different foods rich in many minerals and vitamins such as vitamin D and Calcium, and others rich in protein. Consumption of milk, yogurt, and cheese, foods rich in calcium and protein, slows bone loss and improves insulin-like growth factor 1 that is an important stimulant of protein synthesis in muscle but it also stimulates free fatty acid utilization. Vitamin D is a fat-soluble vitamin that has long been known to help the body absorb and retain calcium and phosphorus; both are critical for building bone.
What could happen with low levels of calcium and protein?
Few studies have investigated the efficacy and safety of a nutritional approach to reduction of fracture risk in aged care residents.
Sandra Luliano of the departments of medicine and endocrinology at the University of Melbourne in Australia and her team 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)
More results of the study…
The diaet added with calcium and protein significantly reduced hip fractures (HR 0.54) and falls (HR 0.89). 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.
However, there wasn’t a significant difference in all-cause mortality between the intervention and control groups, 900 deaths in the dietary intervention group, compared with 1,074 in the control group.
The statistically significant benefits of the dietary supplementation were observed after 3 months.
As we can see , the findings in this study should demonstrate to clinicians how important is the adequate intake of high quality foods, and be used in addition to an osteoporosis treatment, and not just another alternative. And so it is important to think more of the nutritional status of the older population especially, and detect the deficiencies that they could have.
S Iuliano, nutritionist, S Poon, dietician, J Robbins, dietician, (October 21, 2021). Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomized controlled trial. British Medical Journal. Retrieved from : https://www.bmj.com/content/375/bmj.n2364
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