Effects of protein-rich nutritional supplementation and bisphosphonates on body composition, handgrip strength and health-related quality of life after hip fracture: a 12-month randomized controlled study

Lena Flodin, Tommy Cederholm, Maria Sääf, Eva Samnegård, Wilhelmina Ekström, Amer N Al-Ani, Margareta Hedström, Lena Flodin, Tommy Cederholm, Maria Sääf, Eva Samnegård, Wilhelmina Ekström, Amer N Al-Ani, Margareta Hedström

Abstract

Background: The catabolic state that follows hip fracture contributes to loss of muscle mass and strength, that is sarcopenia, which impacts functional ability and health-related quality of life. Measures to prevent such long-term postoperative consequences are of important concern. The aim of this study was to evaluate the combined effects of protein-rich nutritional supplementation and bisphosphonate on body composition, handgrip strength and health-related quality of life following hip fracture.

Methods: The study included 79 men and women with hip fracture, mean age 79 years (SD 9), without severe cognitive impairment, who were ambulatory and living independently before fracture. Patients were randomized postoperatively to receive liquid supplementation that provided 40 g of protein and 600 kcal daily for six months after the fracture, in addition to bisphosphonates once weekly for 12 months (group N, n = 26), or bisphosphonates alone once weekly for 12 months (group B, n = 28). All patients, including the controls (group C, n = 25) received calcium 1 g and vitamin D3 800 IU daily. Body composition as measured by dual-energy X-ray absorptiometry (DXA), handgrip strength (HGS) and health-related quality of life (HRQoL) were registered at baseline, six and 12 months postoperatively.

Results: There were no differences among the groups regarding change in fat-free mass index (FFMI), HGS, or HRQoL during the study year. Intra-group analyses showed improvement of HGS between baseline and six months in the N group (P = 0.04). HRQoL decreased during the first year in the C and B groups (P = 0.03 and P = 0.01, respectively) but not in the nutritional supplementation N group (P = 0.22).

Conclusions: Protein-rich nutritional supplementation was unable to preserve FFMI more effectively than vitamin D and calcium alone, or combined with bisphosphonate, in this relatively healthy group of hip fracture patients. However, trends toward positive effects on both HGS and HRQoL were observed following nutritional supplementation.

Trial registration: Clinicaltrials.gov NCT01950169 (Date of registration 23 Sept 2013).

Figures

Fig. 1
Fig. 1
Flow chart of participants
Fig. 2
Fig. 2
Relationship between appendicular lean mass index and handgrip strength at baseline
Fig. 3
Fig. 3
Outcome of EQ-5D index in different treatment groups at baseline, 6 and 12 months postoperatively. Group C, Controls = vitamin D and calcium for 12 months; B = risedronate, vitamin D and calcium for 12 months; N = protein and energy supplementation for 6 months, and risedronate, vitamin D and calcium for 12 months

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