Articles15 May 1998
A Randomized, Double-Blind, Placebo-Controlled Trial
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    Abstract

    Background:

    Elderly persons who have osteoporotic hip fracture are often undernourished, particularly with respect to protein. Protein malnutrition may contribute to the occurrence and outcome of hip fracture.

    Objective:

    To investigate whether oral protein supplements benefit bone metabolism in patients with recent hip fracture.

    Design:

    6-month, randomized, double-blind, placebo-controlled trial with a 6-month post-treatment follow-up.

    Setting:

    University orthopedic ward.

    Patients:

    82 patients (mean age, 80.7 ± 7.4 years) with recent osteoporotic hip fracture. Patients received calcium supplementation, 550 mg/d, and one dose of vitamin D, 200 000 IU (at baseline).

    Intervention:

    Protein supplementation, 20 g/d, or isocaloric placebo (among controls).

    Measurements:

    Bone mineral density, biochemical markers of bone remodeling, calciotropic hormone levels, biochemically evaluated nutritional and immunologic status, and muscle strength were measured every 6 months.

    Results:

    Compared with controls, patients who received protein supplements had significantly greater increases in serum levels of insulin-like growth factor-I (85.6% ± 14.8% and 34.1% ± 7.2% at 6 months; difference, 51.5 percentage points [95% CI, 18.6 to 84.4 percentage points]; P = 0.003) and an attenuation of the decrease in proximal femur bone mineral density ( −2.29%± 0.75% and −4.71%± 0.77% at 12 months; difference, 2.42 percentage points [CI, 0.26 to 4.59 percentage points]; P = 0.029). Seven and 13 new vertebral deformities were found among patients who received protein supplements and controls, respectively (P > 0.2). Median stay in rehabilitation wards was shorter for patients who received protein supplements than for controls (33 days [CI, 29 to 56 days] and 54 days [CI, 44 to 62 days]; difference, 21 days [CI, 4 to 25 days]; P = 0.018).

    Conclusion:

    Protein repletion after hip fracture was associated with increased serum levels of insulin-like growth factor-I, attenuation of proximal femur bone loss, and shorter stay in rehabilitation hospitals.

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