‘Incredibly cheap’ dietary change could halve risk of hip fractures in older people

Half of elderly people who break their hip in a fall will die within six months. This serious fact prompted Dr. Sandra Julian, a researcher at the University of Melbourne, to work on improving those odds.

“It’s a really horrible way for an older person to live the last few months of their life,” she told a recent conference in London organized by the European Geriatric Medicine Society (EuGMS).

The likelihood of a fracture increases exponentially in women after menopause, and in men from around age 60.

“So you have a group of people in their 80s and 90s who are at high risk of fracture, and now we’re living in our 90s quite comfortably.” In Ireland, the cost and burden on our healthcare system is enormous. Three to four fractures occur every hour – or nearly 90 daily.

Closely linked to fragility fractures, which are steadily becoming more common in Ireland, is osteoporosis, a medical condition that weakens bones, making them fragile and more likely to break.

Of the 209,000 people with osteoporosis in Ireland in 2019, almost 80% were women. Approximately 20% of women and 6.2% of men aged 50 and older suffer from this condition.

However, health care costs remain low compared to our European neighbors. Osteoporotic fractures accounted for around 2% of healthcare expenditure in Ireland in 2019 – or around half a million – which is significantly lower than the European average of 3.5%. The cost to the healthcare system per person is almost €100 per fracture, an increase of 73% over the last decade.

The most alarming thing is that about a third of women in the country do not receive treatment for osteoporosis, and the number of fractures is expected to increase sharply in the coming years.

By 2034, the number of hip fractures among people over 50 is expected to increase by almost 60%, significantly higher than the rest of Europe, with a projected increase of 11%. For those over 75, incidents are expected to increase by 80% for men and 70% for women.

Juliano observed that nursing home residents had inadequate calcium and protein intakes in their diets, both risk factors associated with fractures. She hypothesized that by giving older adults the recommended amount of dairy each day, their bones would have a better chance. The results could not have been more encouraging.

In a study of 7,000 elderly people in care homes in Australia, half received the recommended amount of dairy products each day (five Irish servings – one serving equals a 200ml glass of milk, a 125g pot of yoghurt or a 25g piece of hard cheese) while the other half continued their normal diet.

Juliana and her team of researchers found that those who consumed the recommended servings of dairy products had one-third fewer fractures than those who continued to follow their normal diet. And those who consumed enough dairy in their diet had 46% fewer hip fractures and 11% fewer falls compared to their counterparts.

The significance of the results cannot be understated, and the intervention cost 70 cents per resident per day, much cheaper than many alternative treatments and the final cost to the individual and the economy.

Research has shown that eating milk, yogurt, cheese, and so on slows down weight loss and decreases bone loss.

“Dr Julian’s research has shown a significant reduction in fractures,” said David Armstrong, a National Health Service consultant specializing in osteoporosis, who chaired the panel in London.

If you can show that you can actually reduce fractures, then that’s really impressive, because fractures cost money and kill people.”

He said 10% of people with hip fractures in Northern Ireland end up in nursing homes permanently and this figure is rising every year due to demographic changes as people live longer.

Armstrong emphasized that Julian’s intervention is “incredibly cheap” and should be attractive to politicians and nursing home managers.

Juliana noted that older adults tend to eat about 1.6 kg of food per day, a relatively small amount that requires a high-dairy diet to get the recommended amount of calcium. In comparison, calcium intake through vegetables such as broccoli would require eating 4 kg per day. “They can’t eat enough plant foods to get all the nutrients they need,” she said.

What about the millennials who in a few years will enter nursing homes and beg for plant-based milk? “Looking at alternative milks, some have different protein content and some have no protein. And some of them do not have calcium… If someone gave me money, I would try, but [right now] we don’t know.”

  • Today is World Osteoporosis Day

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