Poverty Linked with Insufficient Calcium and Vitamin D Intake and Osteoporosis Risk

by | Sep 28, 2020 | 2020, Aging, Bone Health, Calcium, Vitamin D - Bone Health

Written by Joyce Smith, BS. This study finds that poverty is a strong risk for osteoporosis in America.

bone healthIt is estimated that 10.2 million (10.3%) people aged 50 years and older in the United States suffer from osteoporosis, with 80% of those cases being females. Additionally, potentially 44% of the population (43.4 million people) have osteopenia, a bone condition that can often lead to osteoporosis 1.Nutrient deficiencies, particularly with respect to adequate levels of calcium and vitamin D (both necessary for the prevention of osteoporosis) is prevalent among the U.S. population, and even more so among lower income individuals and those with food insecurities 2. More than 2 million osteoporosis-related fractures occur each year, burdening the U.S. health care system with over 19 million dollars 3. Age, gender and dietary intake are major contributing factors for osteoporosis. Adequate calcium, necessary for normal bone development 4 is critical for peak bone mass in adolescence and, when insufficient in adults, is associated with increased risk for low bone density, osteoporosis, and fractures and falls 5. According to the Food and Nutrition Board of the National Academies of Medicine recommended daily amount of calcium for adults is 1000 mg for men 51–70 years old, 1200 mg for women 51–70 years, and 1200 mg for all adults 71 years and older 6. Vitamin D, a fat-soluble vitamin that facilitates calcium absorption, is vital for proper function of nerves, muscles and a healthy immune system.

Researchers, using data derived from National Health and Nutrition Examination Survey (NHANES), compiled results of a cross sectional analysis of the U.S population, with a specific focus on the food insecurities of those below the poverty line 7. This study examined the association between markers of poverty with calcium and vitamin D intake and osteoporosis in 3,901 Americans, ages 50 years and older. Poverty indicators such as annual household income (< $20,000), the Family Monthly Level Poverty (FMLP) Index, self-reported food insecurity, and participation in the Supplemental Nutrition Assistance Program (SNAP) were included in the analysis. Additional sub-analyses were performed based on sex and ethnicity.

Study findings revealed that poverty can be a barrier to reliably and routinely acquiring adequate nutrition. In the U.S., 25% of older Americans live at or below the poverty line. Within this population, 68% have inadequate calcium intakes and 46% have inadequate vitamin D intakes. Gender, ethnic, and socio-economic differences impact the overall risk for inadequate calcium and vitamin D intakes and the subsequent osteoporosis risk. Among the key findings were the following:

  • American women over the age of 50 consistently have inadequate calcium intake regardless of their economic status. Inadequate intake of calcium and vitamin D affects poverty-stricken women more than men with respect to osteoporosis risk (16.2% compared to 4.6% of males).
  • Researchers found that of the 3,901 study participants, 60% have inadequate calcium intake (72.4% of females; 51.4% of males) while 36.7% have inadequate vitamin D intake (24.1% of females; 39.7% of males).
  • Inadequate calcium and vitamin D intake was highest among non-Hispanic Blacks, compared to other ethnic groups, while calcium and vitamin D supplementation was lowest in this group.
  • Over one fourth of non-Hispanic Blacks in the US are below the poverty line. Among them 83.4% of females and 63.7% of males have inadequate calcium intake whereas 50.6% of females and 52.6% of males have inadequate vitamin D intake, yet less than 20% take supplements.
  • While low-income non-Hispanic Black males have greater dietary deficiencies, Blacks as a group are least affected by osteoporosis compared to other ethnic groups. However, compared to their higher income counterparts, low-income Blacks have double the risk of developing osteoporosis.

This study does not prove causation; however, it does reveal that poverty is a strong indicator for osteoporosis and suggests that calcium and vitamin D supplementation may benefit this population. Future research should include a longitudinal survey that examines the impact of changes in lifestyle and poverty status on osteoporosis risk factors.

Source: Marshall, Keri, Lynn Teo, Christopher Shanahan, LeeCole Legette, and Susan Hazels Mitmesser. “Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities.” PloS one 15, no. 7 (2020): e0235042.

© 2020 Marshall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.

Click here to read the full text study.

Posted September 28, 2020.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014; 29(11):2520–6. https://doi.org/10.1002/jbmr.2269 PMID: 24771492
  2. Zhang FF, Liu J, Rehm CD, Wilde P, Mande JR, Mozaffarian D. Trends and Disparities in Diet QualityAmong US Adults by Supplemental Nutrition Assistance Program Participation Status. JAMA Network Open. 2018; 1(2):e180237–e. https://doi.org/10.1001/jamanetworkopen.2018.0237 PMID: 30498812
  3. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and EconomicBurden of Osteoporosis-Related Fractures in the United States, 2005–2025. Journal of Bone and Mineral Research. 2001; 22(3):465–75.
  4. Wallace TC, Reider C, Fulgoni VL, 3rd. Calcium and vitamin D disparities are related to gender, age, race, household income level, and weight classification but not vegetarian status in the United States:Analysis of the NHANES 2001–2008 data set. J Am Coll Nutr. 2013; 32(5):321–30. https://doi.org/10. 1080/07315724.2013.839905 PMID: 24219375
  5. Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, et al. Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr. 2010; 140(4):817–22. https://doi.org/10. 3945/jn.109.118539 PMID: 20181782
  6. IOM (Institute of Medicine) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC:The National Academies Press; 2011.
  7. Marshall, Keri, Lynn Teo, Christopher Shanahan, LeeCole Legette, and Susan Hazels Mitmesser. “Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities.” PloS one 15, no. 7 (2020): e0235042.