Life Improving Factors After a Hip Fracture

Study Overview
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Brief Summary
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The primary objective of the proposed research is to investigate the association between protein intake and nutritional status with bone health and physical functioning in older hip fracture patients. In addition, it will be investigated which patient characteristics and modifiable factors can predict mobility, clinical frailty, living situation and mortality. This study will be a 3-month prospective cohort study in adults aged 70 years and older with an acute hip fracture. This study will lead to knowledge about how protein intake and nutritional status in combination with patient characteristics can predict the degree of recovery (bone health and physical functioning) 3 months after the hip fracture. Knowledge on factors related to recovery can contribute to an improved and shorter rehabilitation in the future, which results in a reduction of health care costs.

Detailed Description
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Only half of the patients with an acute hip fracture regain their pre-fracture functional level and 24% dies within the following year. Identifying and targeting modifiable risk factors for optimal recovery after a hip fracture is therefore essential. These factors include protein intake and nutritional status, which may affect markers of bone health and physical functioning and thereby influence recovery. Measurements will be performed at baseline (within 5 days after the hip surgery) and after 3 months during an outpatient clinic visit for the evaluation of the hip fracture surgery. A total of 95 older adults (aged 70 years or older) recovering from an acute hip fracture will be recruited from Rijnstate hospital.

Official Title
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Life Improving Factors After a Hip Fracture

Conditions
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Hip Fractures, Older Adults

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 70 years Community-dwelling Proximal femur fracture: femoral neck fracture/ pertrochanteric fracture, subtrochanteric fracture Able to give informed consent Pre-fracture Clinical Frailty Scale 3-6 Exclusion Criteria: Pathological fracture or periprosthetic fracture Current participation in scientific research that interferes with the proposed study History of dementia No permission to request information from the general practitioner/ treating specialist(s) about medical history, medication use, liver and kidney values, and details about the broken hip

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Protein intake | Dietary protein intake will be recorded using a protein screener which gives an indication of protein intake in g/d. Based on the past 4 weeks. | Baseline | 
| Protein intake | Dietary protein intake will be recorded using a protein screener which gives an indication of protein intake in g/d. Based on the past 4 weeks. | Three months | 
| Nutritional status | Using the Mini Nutritional Assessment Short Form. Subjects will be classified as having a normal nutritional status (12-14 points), having a risk of malnutrition (8-11 points), or being undernourished (0-7 points). | Baseline | 
| Nutritional status | Using the Mini Nutritional Assessment Short Form. Subjects will be classified as having a normal nutritional status (12-14 points), having a risk of malnutrition (8-11 points), or being undernourished (0-7 points). | Three months | 
| Procollagen type 1 N propeptide | Bone turnover marker, in serum | Baseline | 
| Procollagen type 1 N propeptide | Bone turnover marker, in serum | Three months | 
| C-terminal telopeptide of type I collagen | Bone turnover marker | Baseline | 
| C-terminal telopeptide of type I collagen | Bone turnover marker | Three months | 
| Calcaneus quantitative ultrasound parameters | Ultrasound of the calcaneus which gives an indication of the bone density. Device yields the following two parameters: speed of sound (SOS) and broadband ultrasound attenuation (BUA), which can be combined to get the Stiffness Index (SI). | Baseline | 
| Calcaneus quantitative ultrasound parameters | Ultrasound of the calcaneus which gives an indication of the bone density. Device yields the following two parameters: speed of sound (SOS) and broadband ultrasound attenuation (BUA), which can be combined to get the Stiffness Index (SI). | Three months | 
| Insulin-like growth factor 1 | In serum | Baseline | 
| Insulin-like growth factor 1 | In serum | Three months | 
| Parathyroid hormone levels | In serum | Baseline | 
| Parathyroid hormone levels | In serum | Three months | 
| Handgrip strength | Using the Martin vigorimeter | Baseline | 
| Handgrip strength | Using the Martin vigorimeter | Three months | 
| Grip work | Using the Martin vigorimeter | Baseline | 
| Grip work | Using the Martin vigorimeter | Three months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Appendicular skeletal muscle mass | Using bioimpedance spectroscopy | Baseline | 
| Appendicular skeletal muscle mass | Using bioimpedance spectroscopy | Three months | 
| Mobility | Pre-fracture mobility will be assessed with the pre-fracture mobility scale (PMS). The PMS classifies the patient as independent walker, walk with rollator, in a wheelchair or bedridden. | Baseline | 
| Mobility | Mobility at 3 months will be assessed with the Functional Ambulation Categories (FAC). The FAC is scaled from 0 to 5, in which zero means that patient cannot walk or need at least two persons to help and five means independent walker. | Three months | 
| Frailty | Frailty will be assessed with the Clinical Frailty Scale. This scale is graded from 1 to 9 in which level 1 represents 'very fit' and level 9 'terminally ill'. | Baseline | 
| Frailty | Frailty will be assessed with the Clinical Frailty Scale. This scale is graded from 1 to 9 in which level 1 represents 'very fit' and level 9 'terminally ill'. | Three months | 
| Bodyweight | Bodyweight (kg) will be measured with a calibrated sitting weighing scale. | Baseline | 
| Bodyweight | Bodyweight (kg) will be measured with a calibrated sitting weighing scale. | Three months | 
| Barthel Index | This questionnaire determines the degree of (physical or verbal) help a person needs to perform general daily activities. It is graded from 0 (person is completely dependent on others) to 20 (person is completely independent). | Baseline | 
| Barthel Index | This questionnaire determines the degree of (physical or verbal) help a person needs to perform general daily activities. It is graded from 0 (person is completely dependent on others) to 20 (person is completely independent). | Three months |