‘Them bones need calcium, and that’s a natural law’

Calcium has always been synonymous with bone health and dairy products have a deserved reputation as calcium providers. But it can be hard to quantify just how effective and beneficial it can be. Well, a groundbreaking study has found that increasing dairy consumption in older people can drastically improve their health, with potential economic savings also being presented as a result. This may not be a surprise to IFM readers, but this study, completed in Australia, offers some really interesting scientifically proven facts.

The study began with a dietary intervention, whereby 7,000 older residents across 30 residential care homes were given an increase in the amount of dairy they consume every day. It found that residents who consumed 3.5 servings of dairy per day, saw a 46 per cent reduced risk of hip fractures, 33 per cent reduced risk of all fractures and 11 per cent reduced risk of falls – following the two-year study. The authors attributed the findings to the additional calcium and high-quality protein found in dairy foods. They then calculated the cost-saving potential if the dietary changes were to be rolled out nationwide: according to the research, the benefits also extend to the Australian economy and the fracture prevention potential from increasing dairy intake is estimated to equate to over €39m savings in health spend there.

“What the study shows is that when older adults almost double their intake of dairy products they maintain weight, bone density and nutritional status,” says Dr Sandra Iuliano, a senior research fellow in the Department of Medicine, at the University of Melbourne, who led the study. “What we’ve done is slow the decline of bone and muscle by changing the diet of older adults, despite the fact that they’re losing muscle naturally because they’re old.”

Cost of prevention

Professor Frances Dockery is a consultant geriatrician at Beaumont Hospital and joint clinical lead for the National Fracture Liaison Service database in Ireland. She says that the cost of this simple dietary addition is far smaller than the cost of treating fractures and similar injuries: “You have to show value for money in a health service,” she says. “The bottom line was that [serving more dairy] was a cheap intervention with great gains. When you compare that to the cost of a fall or fracture to the person and to the health service, [serving more dairy and protein] is a cost-saving strategy. Interestingly, the cost of intervention in this research study was just 70c per resident, per day.

“In Australia, the typical diet is not hugely different from ours. Older people often don’t have huge appetites, so can sometimes miss out on the nutrition they need to maintain strong bones and good muscle strength that help withstand the risk of falls and fractures. This study has implications for older people in general, not just those in residential or nursing homes because preventing falls and fractures is really important for everyone as they age. 

“There are lots of studies on drug treatments for preventing fractures, which can often be costly and are for select people only who might benefit, but what’s nice about this study is that it’s low cost, feasible, with great benefits for all the older residents.” 

Ireland’s ageing population 

In Ireland, over 300,000 people are thought to have osteoporosis which is a treatable condition, but often the first time they know about it is when they fracture (break) a bone. Fractures account for two per cent of the overall health costs here, which is estimated to be €400m per year. 

“We have a rapidly growing population of older people,” says Frances. “We have one of the highest life expectancies in Europe which we can be very proud of. Rising fracture numbers may come with this however, and fractures can really threaten healthy ageing because they impact a person’s independence. There are already at least 30,000 fractures annually in Ireland, so preventing them is hugely important in an ageing population.”

Professor  Dockery says that a fracture is more than just a painful, physical injury, it can have a knock-on effect on lifestyle and general health: “Falls and fractures are a leading reason for people to enter nursing homes for example,” she says. “Falls can be disastrous because people lose confidence. They mobilise less often because they are so fearful of falling again. If you don’t walk, you don’t fall, so we see peoples’ reluctance to remain active, losing all their fitness and independence. We try to encourage exercise for everyone. It’s healthy for muscle and bones but trying to convince someone who has fallen to exercise more is not always easy – it’s hard to overcome the fear of falling again but with the right support it can be done. 

“For people who break their hip, at least one in five people may not survive more than a year. Of the survivors, only about half get back to their usual level of function so, it can be a life-changing injury. And if you have any fracture from a simple trip or fall, you’re at much higher risk of another in the years ahead so anyone over 50 years of age who has had a fracture should get checked out for their risk of another. 

“This is exactly what a Fracture Liaison Service (FLS) does and these services are all over Europe. The FLS assesses people aged over 50 who have had a recent fracture, checks them out for osteoporosis and falls risk and gives them the right treatments if needed. In Ireland we’re proud to have a long-life expectancy but we want to see healthy ageing, so systems such as the FLS are important for that, and we monitor closely how each FLS is working in Ireland.” 

Sources of calcium

Dairy, of course, is not the only source of calcium and protein and some people can’t tolerate dairy or don’t wish to take dairy products. Other foods such as dark green vegetables, soft bony fish (like sardines), nuts and fortified drinks or cereals also provide calcium, but there is a lack of research to show these foods could have the same impact as this dairy intervention study. Older people tell you that their appetite is not what it used to be. That’s also why that dairy study is appealing – just an extra portion or two of dairy brought up calcium and protein intake really well, it was sustained over time and it was really effective. Maybe plant sources will do the same, but it’s likely that much larger 

quantities are needed for the same amount of protein and calcium which may not work so well in older people with smaller appetites but we don’t have the studies yet to see if it is feasible or beneficial. Until then we should follow the evidence in advising our older people on dietary choices to help prevent falls and fractures. If I see a similar plant-based trial that’s as good, I’ll definitely recommend that too.”

Cheap intervention

When it comes to looking after our bone health, good practice starts early. Protein and calcium intake are hugely important lifelong from our childhood right through to old age. Ultimately, Professor Dockery says, the benefits and the cost-effectiveness of a simple addition to diet is an important finding and is a refreshing change from adding yet another pill or supplement for health benefits.