Protein Supplementation for Hip Fracture Recovery in Elderly Patients: A Randomized Controlled Trial.

Abstract

To evaluate whether protein supplementation improves mobility recovery, nutritional markers, mortality rates, and postoperative complications in elderly patients after proximal femoral fractures. Design: Prospective, randomized, double-blind, placebo-controlled clinical trial.Setting: tertiary academic orthopedic centers. Adults aged ≥ 60 years with radiographically confirmed proximal femoral fractures (OTA/AO 31-A1, 31-A2, 31-A3,31-B1, 31-B2, and 31-B3 ) requiring surgery were eligible. Exclusion criteria included prior supplement use, periprosthetic fractures, renal impairment, severe systemic disease, or contraindications to supplementation. Participants were randomized to receive either a creatine- and HMB-enriched protein supplement or an isocaloric maltodextrin placebo, administered once daily for one month. The primary outcome was mobility recovery measured using the Parker Mobility Score (PMS), compared between groups at 1 and 6 months. Secondary outcomes included serum albumin, hemoglobin, lymphocyte count, total protein, mortality, and postoperative complications. Planned comparisons evaluated biochemical changes from baseline to 1 month, mortality across 6 months, and complications within 1 month. The intervention group (N= 40) had a mean age of 72.3 ± 8.7 years (range: 60-88), with 52.5% males, while the control group (N=40) had a mean age of 73.2 ± 8.9 years (range: 60-90), with 42.5% males. Baseline demographic characteristics were comparable between the two groups. At 1 month, the intervention group showed higher PMS (4.83 ± 0.85 vs. 2.65 ± 0.63; P < 0.001), with no difference at 6 months (6.33 ± 2.4 vs. 6.19 ± 2.9; P=0.859).At 1 month, albumin normalization was observed in all patients in the intervention group compared with 85% of patients in the control group; however, this difference did not remain statistically significant after Bonferroni adjustment (adjusted P=0.219). Other nutritional markers showed no significant intergroup differences (all adjusted P > 0.05). Supplementation was associated with a lower 6-month mortality rate (HR 4.5; 95% CI: 1.12-18.26; P= 0.034). Complication rates within 1 month were similar between groups (N=4 vs. N=8; p = 0.20). In elderly hip fracture patients, creatine- and HMB-enriched protein supplement improved early mobility, accelerated albumin normalization, and was associated with lower 6-month mortality, without affecting complication rates. Level II, therapeutic study.