title: 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.
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.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01950169 (Date of registration 23 Sept 2013).
authors.affiliation: Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden. lena.flodin@karolinska.se.|Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden. lena.flodin@karolinska.se.
authors.forename: Lena
authors.initials: L
authors.lastname: Flodin
authors.affiliation: Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden. tommy.cederholm@pubcare.uu.se.
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.affiliation: Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden. maria.saaf@karolinska.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Sääf
authors.affiliation: Division of Orthopedics, Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. eva.samnegard@ki.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Samnegård
authors.affiliation: Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska University Hospital, Stockholm, Sweden. wilhelmina.ekstrom@karolinska.se.
authors.forename: Wilhelmina
authors.initials: W
authors.lastname: Ekström
authors.affiliation: Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden. amer.al-ani@ptj.se.|Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden. amer.al-ani@ptj.se.
authors.forename: Amer N
authors.initials: AN
authors.lastname: Al-Ani
authors.affiliation: Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden. margareta.hedstrom@karolinska.se.|Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden. margareta.hedstrom@karolinska.se.
authors.forename: Margareta
authors.initials: M
authors.lastname: Hedström
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000203:Activities of Daily Living; D000368:Aged; D001823:Body Composition / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D019587:Dietary Supplements; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000534:rehabilitation; D018737:Hand Strength; D006620:Hip Fractures / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D011788:Quality of Life; D055948:Sarcopenia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D014807:Vitamin D / Q000008:administration & dosage*
chemical_list: D050071:Bone Density Conservation Agents; D004044:Dietary Proteins; D004164:Diphosphonates; D014807:Vitamin D