Objective To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day. Design Two year cluster randomised controlled trial. Setting 60 accredited residential aged care facilities in Australia housing predominantly ambulant residents. Participants 7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years). Intervention Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight). Main outcome measures Group differences in incidence of fractures, falls, and all cause mortality. Results Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08). Conclusions Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000228785. The dataset is available from the corresponding author.

中文翻译：

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钙和蛋白质的膳食来源对住宅护理中老年人髋部骨折和跌倒的影响：整群随机对照试验

目的 评估营养干预对维生素 D 充足但平均摄入量为 600 mg/天钙和 <1 g/kg 体重蛋白质/天的老年人的抗骨折疗效和安全性。设计 两年整群随机对照试验。在澳大利亚设立了 60 家经认可的住宅老年护理机构，主要为可走动的居民提供住宿。参与者 7195 名永久居民（4920 (68%) 名女性；平均年龄 86.0 (SD 8.2) 岁）。干预设施按位置和组织进行分层，30 个设施随机为居民提供额外的牛奶、酸奶和奶酪，这些牛奶、酸奶和奶酪含有 562 (166) 毫克/天的钙和 12 (6) 克/天的蛋白质，总摄入量为 1142 ( 353) mg 钙/天和 69 (15) g/天蛋白质（1.1 g/kg 体重）。30 个控制设施保持其通常的菜单，居民每天摄入 700 (247) 毫克钙和 58 (14) 克/天蛋白质（0.9 克/千克体重）。主要结果测量组在骨折、跌倒和全因死亡率方面的差异。结果分析了来自 27 个干预设施和 29 个控制设施的数据。共观察到 324 例骨折（135 例髋部骨折）、4302 例跌倒和 1974 例死亡。干预与所有骨折风险降低 33% 相关（121 对 203；风险比 0.67，95% 置信区间 0.48 至 0.93；P=0.02），髋部骨折风险降低 46%（42 对 93；0.54，0.35 至 0.83） ; P = 0.005)，跌倒为 11% (1879 v 2423; 0.89, 0.78 至 0.98; P = 0.04)。髋部骨折和跌倒的风险分别在 5 个月（P=0.02）和 3 个月（P=0.004）时显着降低。死亡率没有变化（900 对 1074；风险比 1.01，0.43 至 3.08）。结论 通过使用乳制品来提高钙和蛋白质的摄入量是一种容易获得的干预措施，可以降低老年护理人员经常发生的跌倒和骨折的风险。试验注册澳大利亚新西兰临床试验注册ACTRN12613000228785。该数据集可从相应的作者处获得。