Impact of malnutrition and protein-enriched oral nutrition on early recovery after fragility fractures in older adults: the NuTra trial.

Nearly half of older patients with fragility fractures screened positive for nutritional risk.

• Of 218 patients (mean age 81.8 ± 6.9 years; 72.0% female), 100 (45.9%) screened positive for nutritional risk on NRS 2002 and/or MNA.
• The other 118 (54.1%) screened negative and formed the observational reference group (Group C).
• Participants were aged ≥70 years with fragility fractures admitted to a Level I trauma center in a single-center study.

Patients at nutritional risk were more comorbid, had higher ASA classes and were frailer than patients without nutritional risk.

• Comparison was between the at-risk groups (A and B) and reference group C.
• Nutritional risk was described as closely linked to frailty and multimorbidity.

The protein-enriched diet did not reduce in-hospital medical complications.

• Medical complications occurred in 45.0% of patients overall, with no significant differences between groups.
• Group A (n=46) received a protein-enriched diet targeting 1.5–2.0 g/kg/day; Group B (n=54) received a standard diet.

Serum albumin decreased and CRP increased during hospitalization regardless of group.

• No differences in these changes were observed among the groups, including between intervention and control.

The protein-enriched diet showed no measurable short-term benefit for functional mobility, length of stay or discharge destination.

• Primary outcomes were medical complications, surgical site infections and functional mobility at discharge.
• Secondary outcomes were length of stay, discharge destination and in-hospital mortality.
• The authors concluded the intervention did not translate into measurable short-term benefits on these outcomes.

Patients without nutritional risk were more often independently mobile and discharged home, while all at-risk patients more often needed institutional care.

• Group C patients were more often independently mobile at discharge.
• Patients at nutritional risk, whether in the intervention or control group, more frequently required institutional care.

Age-adjusted Charlson Comorbidity Index, not the nutritional intervention, was independently associated with discharge destination.

• Multinomial logistic regression assessed independent associations with discharge destination.
• A higher age-adjusted CCI was independently associated with discharge destination.
• No independent effect of the nutritional intervention was observed.

The authors suggest nutritional risk should be viewed within overall vulnerability and that nutritional care may need to extend beyond the acute hospital phase.

• They propose embedding nutritional care in comprehensive longitudinal rehabilitation strategies.

The trial was registered retrospectively.

• Registered at ClinicalTrials.gov on 12 May 2026 (NCT07582575).