Extra protein in hospital after a broken hip or pelvis did not get older patients home sooner: a German trial of 218 people over 70 found that frailty, not the menu, decided who went back to living on their own

When an older person breaks a hip, pelvis, spine or shoulder in a simple fall, the days in hospital often decide whether they go back to their own home or into care. Guidelines ask hospitals to screen these patients for malnutrition and to feed them more protein, at least 1.2 to 1.5 g per kilogram of body weight a day and up to 2.0 g during acute illness, to protect muscle and help wounds and bones heal. Most of the trials behind that advice looked only at hip fractures and kept the extra nutrition going well into rehabilitation. The NuTra trial, published on 17 October in BMC Geriatrics by trauma surgeons at the University of Tübingen, asked a narrower question: does a protein-enriched diet during the acute hospital stay alone make a difference?

Between May 2024 and June 2025 the team enrolled 218 patients aged 70 or over with fragility fractures at a Level I trauma centre in Germany. They averaged 81.8 years and 72% were women; almost half had broken the top of the thigh bone and a fifth the pelvis. Within 48 hours of admission everyone was screened with two standard tools, the Nutritional Risk Screening 2002 and the Mini Nutritional Assessment. The 100 patients (45.9%) who screened positive on either were randomised: 46 to a protein-enriched diet and 54 to the usual hospital food. The 118 who screened negative were followed as a comparison group.

The enriched diet aimed for 1.5 to 2.0 g of protein per kilogram a day: three protein-rich main meals and snacks built on yoghurt, quark, cheese, eggs, meat, fish and plant proteins, plus oral nutritional supplement drinks with 20 g of protein a serving. It usually started the day after admission. How much patients actually ate and drank was not measured, so nobody knows whether they reached the target.

On the main outcomes the diet made no measurable difference. At least one medical complication, such as acute kidney injury, a urinary tract infection or pneumonia, hit 39.1% of the enriched-diet group and 50.0% of the usual-diet group, a gap that could be chance. Among patients who had surgery, wound infections were 2.6% against 11.6%, again not statistically significant. Almost everyone (98.6%) left hospital walking worse than before the fracture, and stays averaged 11.5 and 11.6 days. No patient died in hospital and no harms from the diet were recorded.

What did separate patients was where they started. Those at nutritional risk were frailer and had more illnesses: before the fracture only about half of them walked without an aid, against 79.7% of the well-nourished group. At discharge, 30.5% of the well-nourished group went home without extra support, compared with 22.2% on the usual diet and 13.0% on the enriched diet; across all 218 patients, 58.7% went on to a rehabilitation unit, nursing home or other institutional care. In the adjusted analysis the strongest predictor was the burden of other illnesses, with each extra point on an age-adjusted comorbidity score raising the odds of institutional care by about 75%. The authors read nutritional risk as one sign of overall frailty and argue that nutrition care has to continue through rehabilitation, not just the acute stay.

The trial has clear limits. It needed 64 patients per arm and got 46 and 54, so it was too small to rule out a real benefit, especially for uncommon events like wound infections. It was run at one centre, under German reimbursement rules that tend to fix hospital stays at around 11 to 12 days, and it was registered on ClinicalTrials.gov (NCT07582575) only after it had finished. Comparisons with the well-nourished group are observational. The study had no external funding and the authors declare no competing interests. Follow-up at 120 days and 12 months is planned for part of the group.