While a cast plays an essential role in the healing of broken bones, the importance of a well-balanced diet rich in those nutrients known to aid the repair of fractures should not be forgotten. This may not be an issue for many of the people who you provide casting for, but in seniors nutritional deficiencies are more frequent that you may realize. Particularly in frail older adults who report a history of weight loss or poor appetite they may be deficient in a number of key nutrients vital for bone healing. Although this may warrant referral to a dietitian to carry out a detailed nutritional assessment to formulate a treatment plan to boost their dietary intake, it is helpful that you have an awareness of those nutrients critical to bone restoration. While you are probably already well aware of the importance of obtaining enough calcium, what other dietary components are essential?
Diets that include excessive protein are associated with losses of bone mineral density, but a deficiency of protein, which is more likely among the elderly, can impair fracture healing. Protein is beneficial to bone repair in a number of ways. Protein accounts for around half of bone structure by volume and when a bone is broken, the body is required to create new structural proteins within the bone, which requires an adequate supply of dietary amino acids. Adequate protein in the diet also promotes the production of growth factors which have a positive impact on bone renewal and aids the absorption of dietary calcium. Although meat and fish are rich in protein, vegetarians can source sufficient protein from dairy produce, pulses, nuts and seeds. It may in fact be beneficial to obtain more of our protein from these sources, as dairy and plant-based proteins appear to be less damaging to the bones when taken in higher amounts.
This vitamin regulates calcium uptake in the intestines to ensure that there is adequate calcium in the blood to allow appropriate mineralization in the bones, which is particularly important following a fracture. While the action of sunlight on our skin generates vitamin D and regular time spent outdoors is the easiest way to produce sufficient to meet our needs, for anyone housebound or whose mobility is limited, they may easily miss out on this opportunity; this process also becomes less efficient as we age. Few foods in the diet are rich in this vitamin – egg yolks, oily fish such as mackerel, sardines and salmon and fortified foods such as breakfast cereals, milk and margarine are the only real sources. Certainly anyone with osteoporosis is recommended to take a supplement of vitamin D, as are post-menopausal women living in nursing homes or who spend little time outdoors.
Collagen is one of the major proteins in bone important for healing and vitamin C helps to aid collagen formation. This vitamin is sourced from fruit, vegetables and potatoes, with citrus fruits, berries, kiwis, tomatoes, peppers and green vegetables offering some of the richest supplies; anyone with a diet low in fruit and vegetables is likely to be deficient. However, vitamin levels also decline with time and when foods containing the vitamin are heated. Therefore even if someone includes a range of fruit and vegetables in their diet each day, if they are limited how often they can do a grocery shop, rely on canned produce and tend to boil their potatoes and vegetables well, they can be short of this vitamin. Using frozen versions and steaming or microwaving are among the helpful ways to preserve vitamin C levels in food.
Although protein, calcium, vitamin D and C are the nutrients advocated for healing fractures by the American Academy of Orthopedic Surgeons, iron also appears to play an important role and someone with iron deficiency anemia is more likely to experience slower repair of a fracture. Iron is important for both collagen formation and adequate hemoglobin to supply oxygen to the bones which is vital for healing to take place. Red meat and offal are the richest sources of iron, but the darker meat from poultry, oily fish, eggs, fortified breakfast cereals, pulses, dried fruit, leafy greens and wholegrains also offer a useful means to receive dietary iron. Non-meat iron isn’t absorbed as efficiently, but this can be aided by the inclusion of vitamin C rich items at each meal and avoiding tea or coffee near mealtimes.
Although supplements that supply the recommended daily amount can be taken to prevent and correct deficiencies of nutrients, even when these are used the emphasis should be to aim for a nutrient rich diet, as this will provide a range of other health benefits as well as aiding fracture repair.
Article by: Claire Holt