ity. The National Osteoporosis Foundation estimates that there are approximately 1.5 million osteoporosis-related fractures each year: 300,000 at the hip, 700,000 at the spine, 250,000 at the wrist, and 300,000 at other sites (National Osteoporosis Foundation, 1999). The impact of hip fractures on the mortality of the Medicare-age population is significant. A hip fracture is associated with a 20 to 25 percent 1-year mortality rate in women (higher in men), a 25 percent rate of admission to a long-term care setting, and a less than 50 percent likelihood of regaining baseline functional status (National Osteoporosis Foundation, 1999). In 1995, the cost of hip fractures in individuals over 45 years of age were estimated to be $8.7 billion in the United States (Ray et al., 1997). It has also been predicted that these costs could double in the next 30 years (Cummings et al., 1990). While fractures at sites other than the hip are less likely to be associated with mortality, their association with functional impairment, pain, fear, isolation, and depression may not be easily measured but should not be underestimated.
Multiple risk factors for osteoporosis have been defined, and include: (1) estrogen/testosterone deficiency, (2) Caucasian or Asian race, (3) small or thin body habitus, (4) inactivity, (5) alcohol and tobacco use, (6) chronic renal/liver disease, hyperthyroidism, and diabetes, (7) chronic use of pharmacological agents such as glucocorticoids, barbiturates, and phenytoin, (8) inadequate calcium intake, and (9) vitamin D deficiency. This chapter focuses on these last two risk factors, reviewing the role of diet and nutritional supplementation in preventing, delaying, and treating osteoporosis.
Most studies assessing the dietary intakes of free-living (communitydwelling) elderly populations (greater than 65 years of age) in the United States indicate that few individuals are consuming the level of calcium intake recommended as adequate for those over 50 years of age, 1,200 mg/day (IOM, 1997). Indeed, estimates of calcium intake in older women in the United States in 1994 (ARS, 1997) showed an adjusted median intake of 571 mg/day for women 51 to 70 years of age, and a median intake of 517 mg/day for those 71 years and older (IOM, 1997). Only 1 percent of those over age 50 were reported to consume this recommended intake. These estimated intakes are in all likelihood underestimates because the Continuing Survey of Food Intakes by Individuals did not include calcium intakes from supplements or from foods recently available in the market that may have been fortified with calcium.