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Meta-Analysis
. 2016 Nov 30;11(11):CD001880.
doi: 10.1002/14651858.CD001880.pub6.

Nutritional supplementation for hip fracture aftercare in older people

Alison Avenell  1 , Toby O Smith, James P Curtain, Jenson Cs Mak, Phyo K Myint
Affiliations
Meta-Analysis

Nutritional supplementation for hip fracture aftercare in older people

Alison Avenell et al. Cochrane Database Syst Rev. .

Abstract

Background: Older people with hip fractures are often malnourished at the time of fracture, and subsequently have poor food intake. This is an update of a Cochrane review first published in 2000, and previously updated in 2010.

Objectives: To review the effects (benefits and harms) of nutritional interventions in older people recovering from hip fracture.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Embase, CAB Abstracts, CINAHL, trial registers and reference lists. The search was last run in November 2015.

Selection criteria: Randomised and quasi-randomised controlled trials of nutritional interventions for people aged over 65 years with hip fracture where the interventions were started within the first month after hip fracture.

Data collection and analysis: Two review authors independently selected trials, extracted data and assessed risk of bias. Where possible, we pooled data for primary outcomes which were: all cause mortality; morbidity; postoperative complications (e.g. wound infections, pressure sores, deep venous thromboses, respiratory and urinary infections, cardiovascular events); and 'unfavourable outcome' defined as the number of trial participants who died plus the number of survivors with complications. We also pooled data for adverse events such as diarrhoea.

Main results: We included 41 trials involving 3881 participants. Outcome data were limited and risk of bias assessment showed that trials were often methodologically flawed, with less than half of trials at low risk of bias for allocation concealment, incomplete outcome data, or selective reporting of outcomes. The available evidence was judged of either low or very low quality indicating that we were uncertain or very uncertain about the estimates.Eighteen trials evaluated oral multinutrient feeds that provided non-protein energy, protein, vitamins and minerals. There was low-quality evidence that oral feeds had little effect on mortality (24/486 versus 31/481; risk ratio (RR) 0.81 favouring supplementation, 95% confidence interval (CI) 0.49 to 1.32; 15 trials). Thirteen trials evaluated the effect of oral multinutrient feeds on complications (e.g. pressure sore, infection, venous thrombosis, pulmonary embolism, confusion). There was low-quality evidence that the number of participants with complications may be reduced with oral multinutrient feeds (123/370 versus 157/367; RR 0.71, 95% CI 0.59 to 0.86; 11 trials). Based on very low-quality evidence from six studies (334 participants), oral supplements may result in lower numbers with 'unfavourable outcome' (death or complications): RR 0.67, 95% CI 0.51 to 0.89. There was very low-quality evidence for six studies (442 participants) that oral supplementation did not result in an increased incidence of vomiting and diarrhoea (RR 0.99, 95% CI 0.47 to 2.05).Only very low-quality evidence was available from the four trials examining nasogastric multinutrient feeding. Pooled data from three heterogeneous trials showed no evidence of an effect of supplementation on mortality (14/142 versus 14/138; RR 0.99, 95% CI 0.50 to 1.97). One trial (18 participants) found no difference in complications. None reported on unfavourable outcome. Nasogastric feeding was poorly tolerated. One study reported no cases of aspiration pneumonia.There is very low-quality evidence from one trial (57 participants, mainly men) of no evidence for an effect of tube feeding followed by oral supplementation on mortality or complications. Tube feeding, however, was poorly tolerated.There is very low-quality evidence from one trial (80 participants) that a combination of intravenous feeding and oral supplements may not affect mortality but could reduce complications. However, this expensive intervention is usually reserved for people with non-functioning gastrointestinal tracts, which is unlikely in this trial.Four trials tested increasing protein intake in an oral feed. These provided low-quality evidence for no clear effect of increased protein intake on mortality (30/181 versus 21/180; RR 1.42, 95% CI 0.85 to 2.37; 4 trials) or number of participants with complications but very low-quality and contradictory evidence of a reduction in unfavourable outcomes (66/113 versus 82/110; RR 0.78, 95% CI 0.65 to 0.95; 2 trials). There was no evidence of an effect on adverse events such as diarrhoea.Trials testing intravenous vitamin B1 and other water soluble vitamins, oral 1-alpha-hydroxycholecalciferol (vitamin D), high dose bolus vitamin D, different oral doses or sources of vitamin D, intravenous or oral iron, ornithine alpha-ketoglutarate versus an isonitrogenous peptide supplement, taurine versus placebo, and a supplement with vitamins, minerals and amino acids, provided low- or very low-quality evidence of no clear effect on mortality or complications, where reported.Based on low-quality evidence, one trial evaluating the use of dietetic assistants to help with feeding indicated that this intervention may reduce mortality (19/145 versus 36/157; RR 0.57, 95% CI 0.34 to 0.95) but not the number of participants with complications (79/130 versus 84/125).

Authors' conclusions: There is low-quality evidence that oral multinutrient supplements started before or soon after surgery may prevent complications within the first 12 months after hip fracture, but that they have no clear effect on mortality. There is very low-quality evidence that oral supplements may reduce 'unfavourable outcome' (death or complications) and that they do not result in an increased incidence of vomiting and diarrhoea. Adequately sized randomised trials with robust methodology are required. In particular, the role of dietetic assistants, and peripheral venous feeding or nasogastric feeding in very malnourished people require further evaluation.

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Conflict of interest statement

Alison Avenell: none known Toby O Smith: none known James P Curtain: none known Jenson CS Mak: none known Phyo K Myint: none known

Figures

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1
Study flow diagram
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Forest plot of comparison: 1 Multinutrient supplements (oral, nasogastric, intravenous) versus control, outcome: 1.1 Mortality by end of study
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5
Forest plot of comparison: 1 Multinutrient supplements (oral, nasogastric, intravenous) versus control, outcome: 1.2 Participants with complications at end of study
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Funnel plot of comparison: 1 Multinutrient supplements (oral, nasogastric, intravenous) versus control, outcome: 1.1 Mortality by end of study
7
7
Funnel plot of comparison: 1 Multinutrient supplements (oral, nasogastric, intravenous) versus control, outcome: 1.2 Participants with complications at end of study
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References

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    1. Stijn MF, Bruins AA, Vermeulen MA, Witlox J, Teerlink T, Schoorl MG, et al. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial. International Journal of Molecular Sciences 2015;16(6):12288‐306. [DOI: 10.3390/ijms160612288; PUBMED: 26035756] - DOI - PMC - PubMed
Wyers 2013 {published data only}
    1. Breedveld‐Peters J, Reijven PL, Wyers CE, Hendrikx AA, Verburg AD, Schols JM, et al. Qualitative analysis of barriers and facilitators for nutritional intervention in hip fracture patients. Clinical Nutrition, Supplement 2012;7(1):234.
    1. Breedveld‐Peters JJ, Reijven PL, Wyers CE, Hendrikx AA, Verburg AD, Schols JM, et al. Barriers and facilitators of nutritional intervention after hip fracture in integrated care as perceived by the different health care professionals: a qualitative interview study. e‐SPEN Journal 2012;7(5):e182‐8.
    1. Breedveld‐Peters JJ, Reijven PL, Wyers CE, Helden S, Arts JJ, Meesters B, et al. Integrated nutritional intervention in the elderly after hip fracture. A process evaluation. Clinical Nutrition, Supplement 2012;31(1):199‐205. - PubMed
    1. Breedveld‐Peters JJ, Reijven PL, Wyers CE, Helden S, Arts JJ, Meesters B, et al. Integrated nutritional intervention in the elderly after hip fracture. A process evaluation. Clinical Nutrition, Supplement 2012;7(1):43. - PubMed
    1. Dagnelie PC. Effectiveness and cost‐effectiveness of nutritional screening and intervention in elderly subjects after hip fracture. clinicaltrials.gov/show/NCT00523575 (accessed 8 November 2009).

References to studies excluded from this review

Ashworth 2006 {unpublished data only}
    1. Ashworth A. Nutritional supplementation and hip fracture patients ‐ implications for future research trials. Proceedings of the Nutrition Society 2006;65:6A.
    1. Ashworth A. Pilot study to compare nutritional intake of orthopaedic patients supplemented with snacks or oral nutritional supplements. National Research Register (NRR) Archive. portal.nihr.ac.uk/Profiles/NRR.aspx?Publication_ID=N0224145775 (accessed 8 November 2009). [NRR ID: N0224145775]
Bachrach 2000 {published data only}
    1. Bachrach‐Lindström M, Johansson T, Unosson M, Ek A‐C, Wahlström O. Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one‐year follow‐up study. Aging: Clinical and Experimental Research 2000;12:366‐74. - PubMed
    1. Johansson T. Displaced femoral neck fractures. Linkoping University Medical Dissertations no. 731,. Sweden: University of Linkoping, 2002.
Bachrach 2001 {published data only}
    1. Bachrach‐Lindstrom M, Unosson M, Ek AC, Arnqvist HJ. Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture. Clinical Nutrition 2001;20(3):217‐23. - PubMed
Bell 2014 {published data only}
    1. Bell JJ, Bauer JD, Capra S, Pulle RC. Multidisciplinary, multi‐modal nutritional care in acute hip fracture inpatients ‐ results of a pragmatic intervention. Clinical Nutrition 2014;33(6):1101‐7. [DOI: 10.1016/j.clnu.2013.12.003; PUBMED: 24388594] - DOI - PubMed
Beringer 1986 {published data only}
    1. Beringer TR, Ardill J, Taggart HM. Effect of calcium and stanozolol on calcitonin secretion in patients with femoral neck fracture. Bone and Mineral 1986;1(4):289‐95. - PubMed
Boudville 2002 {published data only}
    1. Boudville AC, Bruce DG, Jarman A, Collins T. Do nutritional supplements reduce subsequent food intake in hip fracture patients?. Internal Medicine Journal 2002;32(Suppl):A33.
Bradley 1995 {published data only}
    1. Bradley CF, Kozak C. Nursing care and management of the elderly hip fractured patient. Journal of Gerontological Nursing 1995;21:15‐22. - PubMed
Brocker 1994 {published data only}
    1. Brocker P, Vellas B, Albarede J‐L, Poynard T. A two‐centre, randomized, double‐blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age and Ageing 1994;23:303‐6. - PubMed
    1. Vellas B, Poynard P, et al. Effects of ornithine alpha‐ketoglutarate on elderly malnourished patients: a double‐blind study. Journal of Parenteral and Enteral Nutrition 1993;17(1):34S.
Cameron 2011 {published data only}
    1. Au L, Cameron I, Kurrle S, Uy C. Effectiveness of oral nutritional supplementation for older women with hip and other fractures. Australian Society of Geriatric Medicine Annual Scientific Meeting; 2003 June 16‐18; Melbourne (Australia). 2003.
    1. Cameron ID. Personal communication. 26 November 2014.
    1. Cameron ID, Kurrle SE, Uy C, Lockwood KA, Au L, Schaafsma FG. Effectiveness of oral nutritional supplementation for older women after fracture: rationale, design and study of the feasibility of a randomized controlled study. BMC Geriatrics 2011;11:32. - PMC - PubMed
Carlsson 2005 {published data only}
    1. Carlsson P, Tidermark J, Ponzer S, Soderqvist A, Cederholm T. Food habits and appetite of elderly women at the time of a femoral neck fracture and after nutritional and anabolic support. Journal of Human Nutrition and Dietetics 2005;18:117‐20. [MEDLINE: ] - PubMed
Crossley 1977 {published data only (unpublished sought but not used)}
    1. Crossley A. A longitudinal study of thiamine status and the effect of supplementation in elderly patients recovering from orthopaedic surgery for fractured neck of femur [BSc dissertation]. Surrey (UK): University of Surrey, 1977.
Gegerle 1986 {published data only}
    1. Gegerle P, Bengoa JM, Delmi M, Rapin CH, Loizeau E, Vasey H. Dietary survey on the effect of an oral nutritional supplement after femoral neck fracture [Enquete alimentaire apres fracture du col du femur. Effet d'un supplement dietetique sur les apports nutritionnels]. Schweizerische Rundschau fur Medizin Praxis 1986;75:933‐5. - PubMed
Giaccaglia 1986 {published data only}
    1. Giaccaglia G, Malagù U, Antonelli M, Boschi S, Tabarroni I. Nutritional support in hip fracture operations on the elderly. Experience and results [Il supporto nutrizionale negli interventi di frattura dell'anca nell'anziano. Esperienze e risultati]. Minerva Anestesiologica 1986;52(11):397‐400. - PubMed
Goldsmith 1967 {published data only}
    1. Goldsmith RS, Woodhouse CF, Ingbar SH, Segal D. Effect of phosphate supplements in patients with fractures. Lancet 1967;i:687‐90. - PubMed
Groth 1988 {published data only}
    1. Groth F. Effects of wheat bran in the diet of postsurgical orthopaedic patients to prevent constipation. Orthopaedic Nursing 1988;7(4):41‐6. - PubMed
Gunnarsson 2009 {published data only}
    1. Gunnarsson AK, Lonn K, Gunningberg L. Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?. Journal of Clinical Nursing 2009;18(9):1325‐33. - PubMed
Harju 1989 {published data only}
    1. Harju E, Punnonen R, Tuimala R, Salmi J, Paronen I. Vitamin D and calcitonin treatment in patients with femoral neck fracture: a prospective controlled clinical study. The Journal of International Medical Research 1989;17:226‐42. - PubMed
Harwood 2004 {published data only}
    1. Harwood RH, Sahota O, Gaynor K, Masud T, Hosking DJ. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NoNOF) Study. Age and Ageing 2004;33(1):45‐51. - PubMed
Hedström 2002 {published data only}
    1. Hedstrom M, Sjoberg K, Brosjo E, Astrom K, Dalen N. Changes in soft tissue body composition during treatment with anabolic steroids in women with hip fractures ‐ a prospective randomized study on 64 female patients. Acta Orthopaedica Scandinavica. Supplementum 1998;69(280):31.
    1. Hedström M, Sjöberg K, Brosjö E, Åström K, Sjöberg H, Dalén N. Positive effects of anabolic steroids, vitamin D and calcium on muscle mass, bone mineral density and clinical function after a hip fracture. A randomised study of 63 women. Journal of Bone and Joint Surgery. British Volume 2002;84(4):497‐503. - PubMed
Hitz 2007 {published data only}
    1. Hitz MF, Jensen JE, Eskildsen PC. Bone mineral density and bone markers in patients with a recent low‐energy fracture: effect of 1 y of treatment with calcium and vitamin D. American Journal of Clinical Nutrition 2007;86(1):251‐9. - PubMed
Hoekstra 2011 {published data only}
    1. Hoekstra JC, Goosen JH, Wolf GS, Verheyen CC. Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clinical Nutrition 2011;30(4):455‐61. - PubMed
Holst 2012 {published data only}
    1. Holst M, Rasmussen HH, Laursen MB, Rasmussen S, Porup L, Haals DS. Standard plan for nutrition treatment in hip fracture patients: room for improvement. Clinical Nutrition, Supplement 2012;7(1):118‐9.
Hommel 2007 {published data only}
    1. Hommel A, Bjorkelund KB, Thorngren KG, Ulander K. Nutritional status among patients with hip fracture in relation to pressure ulcers. Clinical Nutrition 2007;26(5):589‐96. [MEDLINE: ] - PubMed
Kacmaz 2007 {published data only}
    1. Kacmaz Z, Kasici M. Effectiveness of bran supplement in older orthopaedic patients with constipation. Journal of Clinical Nursing 2007;16(5):928‐36. [MEDLINE: ] - PubMed
Kuzdenbaeva 1981 {published data only}
    1. Kuzdenbaeva RS, Shaykhiev US, Utegenov BA. Potassium orotate and polyvitamins in the therapy of patients with fractures [Orotat kaliia i polivitaminy pri lechenii bol'nykh s perelomami kostei]. Ortopediia Travmatologiia i Protezirovanie 1981;8:24‐8. - PubMed
Larsson 1990 {published data only}
    1. Larsson J, Unosson M, Ek AC, Nilsson L, Thorslund S, Bjurulf P. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients ‐ a randomised study. Clinical Nutrition 1990;9(4):179‐84. [EMBASE: 1990259199] - PubMed
Lauque 2000 {published data only}
    1. Lauque S, Arnaud‐Battandier F, Mansourian R, Guigoz Y, Paintin M, Nourhashemi F, et al. Protein‐energy oral supplementation in malnourished nursing‐home residents. A controlled trial. Age and Ageing 2000;29(1):51‐6. [MEDLINE: ] - PubMed
Lawson 2003 {published data only}
    1. Doshi MK, Lawson R, Ingoe LE, Colligan JM, Barton JR, Cobden I. Effect of nutritional supplementation on clinical outcome in post‐operative orthopaedic patients. Clinical Nutrition 1998;17 Suppl 1:30.
    1. Lawson R, Doshi MK, Ingoe LE, Colligan JM, Barton JR, Cobden I. Compliance of orthopaedic patients with nutritional supplementation. Proceedings of the Nutrition Society 1998;57:91A. - PubMed
    1. Lawson RM, Doshi MK, Barton JR, Cobden I. The effect of unselected post‐operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients. Clinical Nutrition 2003;22(1):39‐46. - PubMed
    1. Lawson RM, Doshi MK, Ingoe LE, Colligan JM, Barton JR, Cobden I. Compliance of orthopaedic patients with postoperative oral nutritional supplementation. Clinical Nutrition 2000;19(3):171‐5. - PubMed
Li 2012 {published data only}
    1. Li HJ, Cheng HS, Liang J, Wu CC, Shyu YI. Functional recovery of older people with hip fracture: does malnutrition make a difference?. Journal of Advanced Nursing 2012;69(8):1691‐703. - PubMed
Moller‐Madsen 1988 {published data only}
    1. Møller‐Madsen B, Tøttrup A, Hessov I, Jensen J. Nutritional intake and nutritional status of patients with a fracture of the femoral neck: value of oral supplements. Acta Orthopaedica Scandinavica. Supplementum 1988;227:48.
Nusbickel 1989 {published data only}
    1. Nusbickel F, Nelson C, Puskarich C, McAndrew M. Perioperative nutritional evaluation of orthopaedic trauma patients. Orthopaedic Transactions 1989;13(3):756.
    1. Nusbickel FR, Nelson CL, Puskarich CL. Perioperative evaluation of orthopaedic patients. Orthopaedic Transactions 1989;13(3):614‐5.
Olofsson 2007 {published data only}
    1. Lundstrom M, Olofsson B, Stenvall M, Karlsson S, Nyberg L, Englund U, et al. Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging: Clinical and Experimental Research 2007;19(3):178‐86. - PubMed
    1. Olofsson B, Stenvall M, Lundstrom M, Svensson O, Gustafson Y. Malnutrition in hip fracture patients: an intervention study. Journal of Clinical Nursing 2007;16(11):2027‐38. [MEDLINE: ] - PubMed
    1. Stenvall M, Olofsson B, Nyberg L, Lundstrom M, Gustafson Y. Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1‐year follow‐up. Journal of Rehabilitation Medicine 2007;39(3):232‐8. [MEDLINE: ] - PubMed
Pedersen 1999 {published data only}
    1. Pedersen PU. Dietary intervention in elderly patients prevents loss of activities of daily living after orthopaedic surgery [Kostintervention forebygger postoperativt aktivitetstab hos aeldre ortopaedkirurgiske patienter]. Videnskab & Sygepleje 1999;43:52‐74.
    1. Pedersen PU. Nutritional care: the effectiveness of actively involving older patients. Journal of Clinical Nursing 2005;14:247‐55. [MEDLINE: ] - PubMed
    1. Pedersen PU, Cameron U, Jensen L. Active involvement of elderly surgical orthopaedic patients in their own dietary care increases postoperative energy and protein intake [Aktiv inddragelse af aeldre ortopaedkirurgiske patienter i egen kostforplejning oger energi‐ og proteinindtagelsen postoperativt]. Videnskab & Sygepleje 1999;21:28‐44.
Ravetz 1959 {published data only}
    1. Ravetz E. The effect of a protein supplement in the nutrition of the aged. Geriatrics 1959;14:567‐73. - PubMed
Shaikhiev 1984 {published data only}
    1. Shaikhiev US, Kuzdenbaeva RS, Sideshev GI, Lukpanov EK. Regional administration of vitamins C and B1 and calcium gluconate in the treatment of closed diaphyseal fractures [Regionarnoe vvedenie vitaminov C, B1 i gliukonata kal'tsiia pri lechenii zakrytykh diafizarnykh perelomov]. Ortopediia Travmatologiia i Protezirovanie 1984;11:31‐3. - PubMed
Stumm 2001 {published data only}
    1. Stumm RE, Thomas MS, Coombes J, Greenhill J, Hay J. Managing constipation in elderly orthopaedic patients using either pear juice or a high fibre supplement. Australian Journal of Nutrition and Dietetics 2001;58(3):181‐5.
Tassler 1981 {published data only}
    1. Tassler H. Changes in protein fraction and blood glucose level of aged injured patients with standardized oral nutrition [Veranderungen des proteinstatus und der blutzuckerspiegel beim alteren traumatisierten patienten unter standardisierter peroraler ernahrung]. Unfallheilkunde 1981;84(5):213‐5. - PubMed
Taylor 1974 {published data only}
    1. Taylor TV, Rimmer S, Day B, Butcher J, Dymock IW. Ascorbic acid supplementation in the treatment of pressure‐sores. Lancet 1974;2(7880):544‐6. - PubMed
Thomas 2008 {published data only}
    1. Miller M. Individual nutrition therapy and exercise regime: a controlled trial of injured, vulnerable elderly. www.anzctr.org.au/trial_view.aspx?ACTRN=12607000017426 (accessed 19 August 2009). - PMC - PubMed
    1. Thomas SK, Humphreys KJ, Miller MD, Cameron ID, Whitehead C, Kurrle S, et al. Individual nutrition therapy and exercise regime: a controlled trial of injured, vulnerable elderly (INTERACTIVE trial). BMC Geriatrics 2008; Vol. 8:4. Available from www.biomedcentral.com/1471‐2318/8/4 (accessed 08 November 2009). [DOI: 10.1186/1471-2318-8-4] - DOI - PMC - PubMed
Volkert 1996 {published and unpublished data}
    1. Volkert D, Hübsch S, Oster P, Schlierf G. Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6‐month follow‐up. Aging 1996;8(6):386‐95. - PubMed
Williams 1989 {published data only}
    1. Driver L. Evaluation of supplemental nutrition in elderly orthopaedic patients [PhD thesis]. Surrey (UK): University of Surrey, 1994.
    1. Driver LT, Lumbers M, Older J, Williams CM. A controlled trial of sip‐feed supplements in orthopaedic patients: post‐discharge clinical outcome in relation to supplementation and compliance. Proceedings of the Nutrition Society 1990;49:173A.
    1. Williams CM, Driver L, Older J, Dickerson JWT. The use of a nutritional risk score in identifying patients who may benefit from sip‐feed supplementation in hospital [abstract]. Proceedings of the Nutrition Society 1998;47:135A.
    1. Williams CM, Driver LT, Older J, Dickerson JW. A controlled trial of sip‐feed supplements in elderly orthopaedic patients. European Journal of Clinical Nutrition 1989;43(4):267‐74. - PubMed
Wong 2004 {published data only}
    1. Wong SY, Lau EM, Lau WW, Lynn HS. Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial. Journal of Human Nutrition and Dietetics 2004;17:359‐64. [MEDLINE: ] - PubMed
Zauber 1992 {published data only}
    1. Zauber NP, Zauber AG, Gordon FJ, Tillis AC, Leeds HC, Berman E, et al. Iron supplementation after femoral head replacement for patients with normal iron stores. JAMA 1992;267(4):525‐7. - PubMed

References to studies awaiting assessment

Benati 2011 {published data only}
    1. Benati G, Boschi F, Brandolini F, Coppola D, Delvecchio S, Lijoi F, et al. Effects of a perioperative specific oral supplementation in hip fracture old patients. European Wound Management Association Journal 2011;Suppl 2:129.
Bernabeu‐Wittel 2016 {published data only}
    1. Efficacy of ferric carboxymaltose with or without EPO reducing red‐cell transfusion packs in hip fracture perioperative period (PAHFRAC). clinicaltrials.gov/ct2/show/NCT01154491 (accessed 4 December 2015).
    1. Bernabeu‐Wittel M. Personal communication 22 September 2014.
    1. Bernabeu‐Wittel M, Aparico R, Romero M, Murcia‐Zaragoza J, Monte‐Secades R, Rosso C, et al. Ferric carboxymaltose with or without erythropoietin for the prevention of red‐cell transfusions in the perioperative period of osteoporotic hip fractures: a randomized controlled trial. The PAHFRAC‐01 project. BMC Musculoskeletal Disorders 2012;13:27. - PMC - PubMed
    1. Bernabeu‐Wittel M, Romero M, Ollero‐Baturone M, Aparicio R, Murcia‐Zaragoza J, Rincon‐Gomez M, et al. Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial. Transfusion 2016;56(9):2199‐211. - PubMed
Ekinci 2015 {published data only}
    1. Ekinci O, Yanik S, Terzioglu B, Yilmaz Akyuz E, Dokuyucu A, Erdem S. The effect of calcium β‐hydroxy‐β‐methylbutyrate, vitamin D and protein supplementation on postoperative immobilization in elderly malnourished patients with hip fracture: a randomized controlled study. Clinical Nutrition 2015;34(Suppl 1):S102. - PubMed
Gerstorfer 2008 {published data only}
    1. Gerstorfer I, Biswas P, Stundner H, Pienaar S, Elmadfa I, Thaler HW. Therapeutic nutritional care of patients with hip fractures. Clinical Nutrition Supplements 2008;3(1):215.
Ish‐Shalom 2008 {published data only}
    1. Ish‐Shalom S, Segal E, Salganik T, Raz B, Bromberg IL, Vieth R. Comparison of daily, weekly and monthly vitamin D3 in ethanol dosing protocols for two months in elderly hip fracture patients. Journal of Clinical Endocrinology and Metabolism 2008;93(9):3430‐5. - PubMed
Stratton 2006 {published data only}
    1. Stratton RJ, Bowyer G, Elia M. Fewer complications with liquid supplements than food snacks in fracture patients at risk of malnutrition. Clinical Nutrition Supplements 2007;2(2):9.
    1. Stratton RJ, Bowyer G, Elia M. Food snacks or liquid oral nutritional supplements as first‐line treatment for malnutrition in post‐operative patients. Proceedings of the Nutrition Society 2006;65:4A.

References to ongoing studies

ACTRN12609000241235 {published data only}
    1. Miller M. Personal communication 7 September 2014.
    1. Miller M. Does a high dose fish oil intervention improve outcomes in older adults recovering from hip fracture?. www.anzctr.org.au/ACTRN12609000241235.aspx (accessed 8 November 2009).
ACTRN12610000392066 {published data only}
    1. Mak J. Replenishment of Vitamin D in hip fractured patients (REVITAHIP) trial. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335465&isRe... (accessed 23 September 2016).
    1. Mak JC, Mason R, Klein L, Cameron ID. Improving mobility and reducing disability in older people through early high‐dose vitamin D replacement following hip fracture: a protocol for a randomized controlled trial and economic evaluation. Geriatric Orthopaedic Surgery and Rehabiliation 2011;2(3):94‐9. - PMC - PubMed
    1. Mak JS, Klein LA, Finnegan T, Mason RS, Cameron ID. An initial loading‐dose vitamin D versus placebo after hip fracture surgery: baseline characteristics of a randomized controlled trial (REVITAHIP). BMC Geriatrics 2014;14:101. - PMC - PubMed
    1. Mak, JC, Klein LA, Mason RS, Cameron ID. An initial loading‐dose vitamin D versus placebo after hip fracture surgery: gait velocity, falls and mortality in the REVITAHIP study. Fragility Fracture Network Conference, 2014 Sep 4‐6; Madrid. 2014.
ACTRN12612000448842 {published data only}
    1. Harper M. Does Intravenous iron therapy reduce the need for blood transfusion and improve post operative blood count following surgery for broken neck of femur. www.anzctr.org.au/TrialSearch.aspx?searchTxt=362379&isBasic=True (accessed 23 September 2016).
NCT00497978 {published data only}
    1. Houdijk AP. Personal communication 18 September 2014.
    1. Houdijk AP. The effect of taurine on morbidity and mortality in the elderly hip fracture patient. clinicaltrials.gov/show/NCT00497978 (accessed 8 November 2009).
NCT01404195 {published data only}
    1. Malafarina V. Hyperprotein nutritional intervention in elderly patients with hip fracture and sarcopenia (HIPERPROT). clinicaltrials.gov/ct2/show/NCT01404195 (accessed 4 December 2015).
    1. Malafarina V, Uriz‐Otano F, Gil‐Guerrero L, Iniesta R, Zulet MA, Martinez JA. Study protocol: high‐protein nutritional intervention based on β‐hydroxy‐β‐methylbutirate, vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT‐GER study. Maturitas 2013;76(2):123‐8. - PubMed
NCT01505985 {published data only}
    1. Bischoff‐Ferrari H. Hip fracture surgery and oral nutritional supplements (HIATUS). clinicaltrials.gov/ct2/show/NCT01505985 (accessed 9 December 2015).
Rowlands {published data only}
    1. Rowlands M, Forward DP, Sahota O, Moppett IK. The effect of intravenous iron on postoperative transfusion requirements in hip fracture patients: study protocol for a randomized controlled trial. Trials 2013;14(1):288. - PMC - PubMed

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References to other published versions of this review

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