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Article Excerpt
Osteoporosis is a major public health threat that is largely preventable (National Institutes of Health [NIH], 2001). In the United States, 10 million people have osteoporosis, and another 18 million have osteopenia--low bone mass that increases the risk for osteoporosis (NIH, 2001). Consequences of osteoporosis include chronic pain, bone fractures, need for placement into long-term care facilities, and death (NIH, 2001).
Because of the high prevalence and debilitating consequences of osteoporosis and bone fractures, we developed an educational intervention related to nutrition and bone health that was targeted to participants in the Older Americans Nutrition Program (OANP). Formerly known as the Elderly Nutrition Program, OANP is the largest community nutrition program for older adults in the Nation, serving about 7 percent of the older population overall and about 20 percent of the poor elders (Administration on Aging, 2002; Millen, Ohls, Ponza, & McCool, 2002). This program provides nutrition education, as well as congregate and home-delivered meal services.
The educational messages in this intervention were developed from recommendations of the 2000 NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (NIH, 2001). From a review of 2,449 references from 1995 to 1999, the panel identified several modifiable risk factors for osteoporosis and bone fractures, including smoking, a low level of physical activity, risk of falling, and low intakes of calcium and vitamin D. Further evidence that smoking and use of smokeless tobacco are risk factors was recently reviewed (Spangler, Quandt, & Bell, 2001).
Although NIH did not make a specific recommendation for physical activity and the prevention of osteoporosis and fractures, several health organizations and experts recommend 30 minutes or more physical activity most days of the week (about 30 minutes on 5 days of the week and about 150 minutes weekly) (American College of Sports Medicine, 2002; U.S. Department of Health and Human Services [DHHS], 2000; DiPietro, 2001; USDA & DHHS, 2000). The NIH panel (2001) emphasized that exercise may decrease the risk of falling. This focus on exercise is critical because most (90 percent) hip fractures are associated with a fall (Carter, Kannus, & Khan, 2001). Both the NIH (2001) and the National Osteoporosis Foundation (NOF, 2002) recommend fall-prevention techniques in the home such as: removing throw rugs, anchoring rugs with nonskid tape, installing grab bars and stair rails, and using night-lights. These types of interventions have reduced the number of falls (Plautz, Beck, Selmar, & Radetsky, 1996).
Vitamin D is unique because it can be obtained both via skin exposure to sunlight and through food or supplements. Like all other vitamins and minerals, calcium is available only through food or supplements. Although calcium- and vitamin D-rich foods (e.g., dairy products) are the preferred source of dietary calcium and vitamin D, several organizations suggest that older people may need supplements to meet their high needs for these nutrients (NAS, 1997; NIH, 2001 ; USDA & DHHS, 2000). The ability to synthesize vitamin D in the skin by sun exposure declines with age and is blocked by sunscreen in people regardless of their age (NAS, 1997).
The Adequate Intake (AI) level for vitamin D (600 International Units [IU] or 15 rag) for those over 70 years old is often difficult to achieve. With the exception of milk, which is fortified in the United States with 400 IU of vitamin D per quart (Institute of Medicine, 1997), very few foods contain vitamin D in significant quantities. Consequently, relying on milk alone would require 6 cups of milk per day to meet the recommendation. Perceived milk intolerance--defined as experiencing stomach ache, flatulence, or diarrhea after drinking milk--is much higher in African Americans than in Caucasians and is a significant predictor of low milk intake in older adults (Elbon, Johnson, & Fischer, 1998). The 2000 Dietary Guidelines for Americans states that "people who seldom eat dairy products or other rich sources of calcium need a calcium supplement" and that "older adults and people...
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