Background – Falls and fractures are common in aged-care residents and are a costly health burden. Sub-optimal nutritional intake, especially that of calcium, protein and vitamin D may contribute to fragility fractures and falls risk either by directly affecting metabolic process or functions, or by affecting body composition.
Objectives – To determine the risk factors for falls and fractures in ambulatory aged care residents.
Design – Cross sectional analysis of 82 aged care residents (mean age 86.2 yrs) from 18 hostels in Melbourne. Nutrient intake was determined from 3 day weighed food intake. Bone mineral density (BMD) was ascertained using DXA. Balance, leg strength and functional capacity were measured using established methods. Blood samples were drawn and analysed for 25(OH) vitamin D, PTH, creatinine, albumin, and bone metabolism. Medical records were reviewed to determine medication use, medical conditions and fracture history. Prospective falls data was collected over a 12-month period.
Outcomes – Over the 12 months, falls were reported in half of residents, with 100 falls recorded. One third of residents had a history of fractures. Mean calcium (668 mg/day) and protein (0.82 g/kg BW) intakes were below recommended levels. 34% had vitamin D levels below 30 nmol/L. Residents with a history of fractures consumed less calcium and had less lean mass, after adjusting for size (P<0.05). Fracture sufferers had reduced leg strength, lower femoral neck BMD (P<0.05) and tended to have reduced functional capacity (P< 0.1). Fallers were heavier and had a higher BMI than non-fallers (P<0.05), and tended to demonstrate more body sway (P< 0.1). Those with vitamin D levels below 30 nmol/L tended to have lower functional capacity and more body sway (P<0.1). Conclusion – Risk factors for falls or fractures appear to differ. The potential for vitamin D to improve balance and functional capacity and calcium to reduce fracture risk in this group, warrants further investigation. Protein intake was not related to falls or fractures in this group. However, frank protein deficiency may contribute to risk factors.