The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
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8 Osteoporosis
8 Osteoporosis
Pages 152-162
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From page 152... ...
has defined osteoporosis and its precursor, osteopenia, as follows: osteopenia is defined as having a bone density one or more standard deviations below the gender-specific mean for a normal 25 year old; osteoporosis is defined as greater than 2.5 standard deviations below the same mean; severe osteoporosis is defined as greater than 2.5 standard deviations below the mean with clinical fractures. It should be noted that these definitions are not based on a pathologic classification of the disease but merely attempt to quantitate the degree of the problem according to relative bone mineral density (BMD)
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From page 153... ...
, 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~.
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From page 154... ...
Because of substantial improvements in the technology for measuring BMD in the last decade, this review focuses only on the most recent randomized controlled trials. However, it should be noted that a review of calcium supplementation studies prior to 1991 (Dawson-Hughes, 1991)
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From page 155... ...
A recent study looked at the effect of 1,000 mg/day of calcium supplementation for 2 years on seasonal bone loss in nonosteoporotic women over age 65 living in the state of Maine, with an estimated baseline calcium intake of less than 800 mg/day (Storm et al., 1998~. The investigators compared a placebo control group to two different calcium supplementation regimens: (1)
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From page 156... ...
The importance of calcium supplementation at a level greater than 1,000 mg/day is underscored in this study since the high-calcium supplement group lost less bone in most sites than the milk drinkers who were also receiving vitamin D supplementation in their milk. Vitamin D Supplementation Other studies have recently looked at the effect of vitamin D intake as part of an overall approach to maintaining bone mass.
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From page 157... ...
Most importantly, clinical trials now suggest that oral supplementation of vitamin D can reduce bone loss. In a 2-year trial in healthy postmenopausal women living in a northern latitude of the United States, whose estimated baseline dietary intake of vitamin D was only 2.5 mg (100 IU)
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From page 158... ...
Although not yet determined to be a primary indication for calcium supplementation, some recent studies suggest positive influences of higher calcium intakes on blood pressure (Griffith et al., 1999) and colon tumors (Baron et al., 1999~.
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From page 159... ...
SUMMARY AND RECOMMENDATIONS Enhanced intake of calcium and vitamin D for both the prevention and treatment of osteoporosis in the at-risk Medicare population is strongly supported by a considerable body of data including multiple randomized controlled trials. It must be noted that adequate calcium and vitamin D are also critical for the accretion of maximal bone mass, which occurs much earlier in life.
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From page 160... ...
However, for individuals who would prefer to meet and sustain adequate intakes of calcium and vitamin D without supplements, nutrition counseling by a nutrition professional with training equivalent to that of a dietitian may be warranted, particularly for individuals with other nutrient restrictions or unique meal planning circumstances. Summary of Evidence: Nutrition Interventioni for Osteoporosis Consensus statements: Observational studies: Randomized trials: Systematic review: Recommended as part of the standard of care by the World Health Organization (1994)
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From page 161... ...
1999. The influence of dietary and nondietary calcium supplementation on blood pressure: An updated metaanalysis of randomized controlled trials.
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From page 162... ...
1998. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: A randomized placebo-controlled trial.
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