Preventing falls and fractures in low-level aged-care residents by increasing dairy food intake by two serves per day.

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Falls and fracture rates are highest in elderly in low-level aged-care than those in nursing homes or in the community, so this is the highest risk group and most likely to benefit from interventions. Drugs cannot be given to large numbers of people so non-drug approaches are needed to reduce the burden of fractures, but must be effective, safe, easily administered, readily available and low cost. Low protein and calcium intakes increase falls and fracture risk because muscles weaken, balance worsens and bone breaks down more quickly making them more susceptible to fractures. On average low-level aged-care residents consume two or less serves of dairy foods per day with more than 75% of residents below the recommended intakes levels for protein and calcium. Dairy foods are a good source of protein and calcium, and fulfill the requirements of safe, accessible, easy to administer and low cost. We aim to determine if two additional serves of dairy food per day will corrected these deficiencies and reduce the rate of falls and fractures in low-level aged-care residents by maintaining muscle mass and function and slowing bone loss. We will study this over 2 years by ensuring that residents consume 4 serves of dairy foods per day. Food service staff with be trained and supported to modify the menus to improve dairy food intake. We will recruit 3000 residents in 60 aged care facilities; 30 facilities will be randomized to intervention and 30 serving as controls. Residents will be transported under supervision to the Heidelberg Repatriation Hospital for bone, balance and body composition measures. Fractures will be monitored in residents from incident reports and verified using hospital medical records. Bone turnover will be measured using serum bone metabolic markers, bone structure measured using high resolution peripheral quantitative computed tomography (HR-pQCT) and bone density and body composition measured using densitometry (DXA). Strength and physical function and questionnaires will be assessed at facilities. All tests are performed before the intervention begins, bloods and strength re-assessed at 3 months and bone structure, density and body composition measured again at 12 months. This study will be the first to assess the anti-fracture efficacy of dairy foods, and the mechanisms and structural basis for this reduction in fracture risk. If anti-fracture efficacy is demonstrated it will provide evidence for a safe, low cost, widely available approach to reduce the burden of fractures in the community.