Physicians Underestimate Calcium Intake in Women

Osteoporosis is a chronic disease characterized by low bone-mineral density and disturbances in skel-etal microarchitecture, leading to fragility fractures.1 Consequences of osteoporosis include chronic pain, disability, and premature death.2 An estimated 10 mil-lion Americans have osteoporosis, and an additional 34 million have low bone mass.3,4 Adequate calcium intake throughout the lifespan is necessary to optimize bone health.5-7 Unfortunately, na-tional nutritional surveys consistently demonstrate that American women fail to achieve recommended intake of calcium through diet and/or supplementation.8 While at least half of women recall receiving calcium intake counseling by their physician,9-10 how that counseling is provided and whether it is effective in optimizing calcium intake has not been studied. Individualized calcium intake counseling requires an initial estimate of present intake and determination of adequacy, followed by tailored advice on how to meet or maintain optimum intake. The increasing market availability of calcium-fortified foods and beverages could render “bedside ” clinical estimation of calcium intake more complex.11,12 The purpose of this study was to assess the accuracy of rapid physician-estimated calcium intake during office encounters compared to a validated measure of calcium intake and to characterize those women whose intakes were incorrectly classified as inadequate by physicians. We hypothesize that clinicians, focusing on dairy and supplemental calcium sources, will tend to underestimate total calcium intake, primarily because of calcium-fortified food sources