Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities

PLoS One. 2020 Jul 8;15(7):e0235042. doi: 10.1371/journal.pone.0235042. eCollection 2020.


Poverty may be a barrier to acquiring adequate nutrient levels for the prevention of osteoporosis. Age and nutritional intake are major factors that contribute to osteoporosis prevalence. This study examined the relationship between markers of poverty with calcium / vitamin D intake and osteoporosis. A cross-sectional analysis of the United States population was performed using National Health and Nutrition Examination Survey (NHANES) data from 2007-2010 and 2013-2014 for older US adults (n = 3,901 participants, 50 years old and older). Odds of inadequate calcium / vitamin D intake and dietary supplement use and risk of probable osteoporosis were calculated in order to determine the relative difference and possible associations between household income, the Family Monthly Poverty Level Index, food security, and participation in the Supplemental Nutrition Assistance Program (SNAP). A sub-analysis of ethnic disparities and biological sex was also performed. In general, women age 50 and older consistently have inadequate calcium intake, regardless of economic level including poverty. While inadequate calcium intake has a larger prevalence among women, markers of poverty increased the risk of inadequate calcium intake in all men and risk of osteoporosis among some subgroups, with the exception of SNAP program participation. Over one fourth of Non-Hispanic black men in the US are below the poverty line. Approximately half of this population has inadequate calcium (58.9%) and vitamin D (46.7%) intake. Typically, osteoporosis risk is relatively low for Non-Hispanic Black males, however considering poverty status, risk is significantly increased (Relative Risk Ratio [RR]: 2.057 ± 0.012) for those with low income suggesting that calcium and vitamin D supplementation may be of benefit for this population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Calcium, Dietary* / therapeutic use
  • Cross-Sectional Studies
  • Dietary Supplements
  • Female
  • Food Supply
  • Humans
  • Male
  • Middle Aged
  • Nutritional Status*
  • Osteoporosis / etiology*
  • Osteoporosis / prevention & control
  • Poverty
  • Risk Factors
  • Vitamin D* / therapeutic use
  • Vitamins / therapeutic use


  • Calcium, Dietary
  • Vitamins
  • Vitamin D

Grants and funding

This work was supported by Pharmavite LLC. Pharmavite LLC had a role in the study design, data collection and analysis, decision to publish, and preparation of the manuscript. Pharmavite provided support in the form of salaries for authors KM, LL and SHM. The specific roles of these authors are articulated in the ‘author contributions’ section.