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

OBJECTIVES: To evaluate whether protein supplementation improves mobility recovery, nutritional markers, mortality rates, and postoperative complications in elderly patients after proximal femoral fractures. METHODS: Design : Prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: tertiary academic orthopedic centers Patient Selection Criteria: 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. Outcome Measures and Comparisons: 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. RESULTS: 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). CONCLUSIONS: 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 of Evidence: Level II, therapeutic study.