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Protein Supplements Increase Serum Insulin-Like Growth Factor-I Levels and Attenuate Proximal Femur Bone Loss in Patients with Recent Hip Fracture: A Randomized, Double-Blind, Placebo-Controlled Trial

Marc-Andre Schurch, MD; Rene Rizzoli, MD; Daniel Slosman, MD; Laszlo Vadas, PhD; Philippe Vergnaud, PhD; and Jean-Philippe Bonjour, MD
[+] Article and Author Information

For author affiliations and current author addresses, see end of text. Grant Support: By grants from Sandoz Nutrition Ltd., Berne, Switzerland, and the Swiss National Research Science Foundation (grant no. 32-32415.91). Skin-test antigens for cellular hypersensitivity systems were supplied by Rhone-Poulenc, Thalwil, Switzerland. Acknowledgments: The authors thank M.N. Cerutti, RN, for devoted care of the patients; M. Jackson, RN, for help with patient recruitment; the staff of the osteodensitometry unit of Geneva University Hospital; G. Fourticq for muscle strength assessment; J.-L. Nussbaum for performing radiography; G. Rapatz (Institute for Medical Outcome Research) for statistical analysis; M. Perez for secretarial assistance; and E. White, MD, for reading the manuscript. They also thank J.-M. Dayer, MD; C.-H. Rapin, MD; J.-P. Michel, MD; H. Vasey, MD; P.D. Delmas, MD, PhD; and H. Schneider, PhD, for helpful discussion and support. Requests for Reprints: Rene Rizzoli, MD, Division of Bone Diseases, Department of Internal Medicine, University Hospital, CH-1211 Geneva 14, Switzerland; e-mail rizzoli@cmu.unige.ch. Current Author Addresses: Drs. Schurch, Rizzoli, and Bonjour: Division of Bone Diseases, World Health Organization Collaborating Center for Osteoporosis and Bone Disease, Department of Internal Medicine, University Hospital, CH-1211 Geneva 14, Switzerland.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(10):801-809. doi:10.7326/0003-4819-128-10-199805150-00002
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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.

Figures

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Figure 1.
Effect of protein supplements on serum levels of insulin-like growth factor-I (IGF-I) in patients with recent hip fracture.PP

Results are the mean ± SE and are expressed as a percentage of baseline values. The solid line represents patients who received protein supplements; the dashed line represents controls. *  = 0.055; **  = 0.003 for comparison with controls (analysis of variance).

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Grahic Jump Location
Figure 2.
Effect of protein supplements on bone mineral density (BMD) of the proximal femur in patients with hip fracture 12 months earlier.P

Results are given as the mean ± SE and are expressed as a percentage of baseline values. The solid line represents patients who received protein supplements; the dashed line represents controls. *  = 0.029 for comparison with controls (analysis of variance).

Grahic Jump Location

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