Increasing intake of dietary calcium and protein in older adults who have adequate vitamin D levels reduces the risk of falls and fragility fractures, according to a new BMJ study from Australia.

The randomized controlled trial involved institutionalized, but ambulatory 7195 older adults, mean age 86 years. Women participants were 4920 (68%) in number. They had sufficient vitamin D levels, but their intake of calcium and protein was lower than 1300 mg/day and 1 g protein per kg body weight, respectively. Residents of 30 facilities were given diets with extra milk, yogurt, cheese, and calcium supplements amounting to 1142 mg of calcium/day and 1.1 g/kg body weight of protein (69 g/day). Residents of the other 30 facilities, which acted as the control group, continued with their regular diets (700 mg/day calcium and 0.9 g of protein per kg body weight (58 g/day).

After two years, there were 324 fractures in total (121 in the study group versus 203 in the control group) and 4302 falls; 1974 deaths occurred during the study. Addition of calcium and protein in diet reduced risk of all fractures by 33% (121 versus 203), and falls by 11% (1879 v 2423). The risk of hip fractures reduced by 46% with fewer hip fractures occurring in the intervention group compared to the control group; 42 versus 93, respectively. The risk reduction in hip fractures became evident after three months of the dietary intervention. However, there was no difference in all-cause mortality between the two groups (900 versus 1074).

This study highlights the importance of educating older adults about adequate nutrition, particularly calcium and proteins by using readily available dairy foods, to reduce their risk of falls and fractures as complementary to anti-osteoporotic drugs. Sandra Luliano of the departments of medicine and endocrinology at the University of Melbourne in Australia and lead author of the study said, “If someone is deficient and we improve their intakes to recommended levels then a benefit is likely, as we observed. If their intake of calcium and protein and dairy foods was sufficient, then we would be less likely to see a benefit.”

Reference

1. Iuliano S, et al. 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.