Nutrition: To supplement or not to supplement the elderly

Abstract

Worldwide, the population is expanding, and life expectancy lengthening. By 2050, people aged over 80 years will number almost 380 million. Fracture risk increases with age therefore the elderly will contribute significantly to the fracture burden. Drug therapy to reduce facture risk in the elderly is not feasible but dietary modifications, specifically improving protein, calcium, and vitamin D intakes may be a realistic option. Relationships between protein, calcium, and vitamin D and fracture risk in community-dwelling elderly is inconclusive. However few in the community are truly deficient in these nutrients. Nutrient deficiencies are more common in institutionalized elderly in whom fracture risk is high. This group is ideal to target, as fewer require treatment to prevent fractures. Potential methods of treatment include supplementation, fortification or dietary changes. Individually neither calcium nor vitamin D supplementation have been effective in reducing fractures in the elderly, but combined therapy in institutionalized elderly demonstrated fracture risk reduction of ˜30-40%. No studies have specifically investigated the anti-fracture efficacy of oral nutritional supplements in the elderly, but falls reduction has been observed in hospital settings. Food fortification with calcium and vitamin D has shown beneficial to bone with reductions in PTH, bone resorptive markers and bone loss reported, but the anti-fracture efficacy has not been investigated. Alternatively correcting diet quality, specifically increasing dairy consumption to recommended levels in institutionalized elderly may potentially have anti-fracture benefits, but this requires large-scale trials to elucidate. Ensuring nutritional adequacy in the elderly may prove vital to curb the fracture burden.