老年化是台灣未來人口結構的趨勢，隨之而來的是龐大的健康照顧需求。而老年人所採取的健康行為以及營養補充，會對高齡人口的整體健康狀態有著深遠而顯著的影響。過去的研究顯示，鈣質的攝取及補充對於骨質疏鬆及髖骨骨折或脊椎壓迫性骨折等具有預防效果，亦有研究指出可以預防大腸直腸癌及大腸腺瘤的復發。本論文希望探討台灣地區老年人服用鈣片以補充鈣質攝取的情況，根據國民健康局台灣地區老年人營養及健康調查進行分析。以1999年的資料中年齡70歲以上且並未服用鈣片的1393位老人為研究對象，分析其本身的健康行為、罹病狀況、經濟狀況等因素對服用鈣片習慣的影響及相關性。將經過卡方檢定後所得到支具有顯著意義的自變項納入，然後進行多變項邏輯回歸分析。結果顯示：女性、有運動習慣、教育程度較高者以及有服用維他命或礦物質習慣者較有可能採取鈣片補充的行為。而老人疾病病史以及跌倒經驗對於補充鈣片的行為並不具有顯著意義。若以性別分層分析，則男性出現補充鈣質的行為改變與教育程度、非獨居及糖尿病的有無相關；女性則與教育程度、經濟狀況與運動習慣相關。以上之發現，希望有助於瞭解老年人採取鈣質補充的意願及目的，以及攝取其他保健食品或營養補充品的行為模式。

Taking calcium supplements is considered a health behavior to prevent osteoporosis and fractures among elderly. The purpose of this study is to explore the relationship between the change of the habit to take calcium supplements and background variables of elderly in Taiwan. A population based sample followed from 1999 to 2003. A total of 1393 elderly (age>70) who had no preexistent habit of taking calcium supplements completed the follow-up. We collected data including background information, health behaviors, preexistent disease, the habit of taking alternative medicine and nutrition supplements. The outcome variable is whether the elderly changed into taking calcium supplements on 2003.
The prevalence of the use of calcium supplements ( age>70 y/o) is 14.7% in 1999 and 16.1% in 2003. The logistic regression showed that female, higher education level, regular exercise, and taking multivitamins and minerals are predictive factors of taking calcium supplements after 4-year follow-up. Other associated variables are : not living alone, no smoking, acceptable financial status, and diabetes mellitus. In the subgroup of female, education level, financial status, and regular exercise are associated with taking calcium supplements. In male, education level, not living alone and having diabetes mellitus are associated with taking calcium supplements. Osteoporosis, hip fractures and recent falls were not found to be associated with taking calcium supplements in elderly. The elderly who had high risk of osteoporosis and fracture did not take calcium supplements as prevention of fractures or osteoporosis. Further effort should focus on introducing more health education to the elderly, especially those who have risks.

誌謝------------------------------------------------------I
中文摘要-------------------------------------------------II
英文摘要------------------------------------------------III
第一章 緒論-----------------------------------------------1
第一節 前 言-------------------------------------------1
第二節 文獻回顧----------------------------------------3
第三節 理論依據----------------------------------------8
第四節 研究架構---------------------------------------10
第二章 研究方法------------------------------------------11
第一節 研究對象---------------------------------------11
第二節 研究工具---------------------------------------14
第三節 統計分析---------------------------------------15
第三章 結果----------------------------------------------16
第四章 討論----------------------------------------------20
第一節 研究結果之討論---------------------------------20
第二節 研究限制及未來研究的方向-----------------------24
第五章 結論與建議----------------------------------------26
第一節 結論--------------------------------------------26
第二節 對老人衛教及公共衛生方向之建議------------------27
參考文獻-------------------------------------------------28
附表-----------------------------------------------------37
表一、1999年及2003年老年族群的補充鈣片盛行率及人口學特徵----37
表二、樣本特性與補充鈣質行為的分析---------------------------38
表三、樣本病史與補充鈣片行為分析-----------------------------39
表四、樣本服用藥品與補充鈣片行為分析-------------------------41
表五、追蹤4年後補充鈣片習慣從無變為有之邏輯回歸分析結果-----42
表六、女性樣本特性與吃鈣片行為分析---------------------------43
表七、女性樣本病史與補充鈣片行為分析-------------------------44
表八、女性樣本補充鈣片習慣從無變為有之邏輯回歸分析結果-------46
表九、男性樣本特性與吃鈣片行為分析---------------------------47
表十、男性樣本病史與補充鈣片行為分析-------------------------48
表十一、男性樣本補充鈣片習慣從無變為有之邏輯回歸分析結果-----50
附錄一、1999年台灣地區中老年身心社會生活狀況長期追蹤調查問卷---51

1.內政部人口政策委員會 (2004)：人口組成變遷與未來人口政策方向。
2.Boonen S, Singer AJ. Osteoporosis management: impact of fracture type on cost and quality of life in patients at risk for fracture I. Curr Med Res Opin. 2008；24:1781-8.
3.Caliri A, De Filippis L, Bagnato GL, Bagnato GF. Osteoporotic fractures: mortality and quality of life. Panminerva Med. 2007 49:21-7.
4.Pande I, Scott DL, O''Neill TW, Pritchard C, Woolf AD, Davis MJ. Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis. 2006；65:87-92.
5.行政院衛生署（2003）國人膳食營養素參考攝取量及其說明，pp257-341，台北市。
6.行政院衛生署1999-2000（2004）老人營養現況-台灣地區老人營養健康狀況調查，pp1-23，台北市。
7.Rizzoli R. Nutrition: its role in bone health. Best Pract Res Clin Endocrinol Metab. 2008;22:813-29.
8.Morgan KT. Nutritional determinants of bone health. J Nutr Elder. 2008;27:3-27.
9.Kubota M, Shimizu H. Calcium in aging, health, and anti-aging. Significance of calcium supplement for anti-aging. Clin Calcium. 2008;18:973-9.
10.Power, ML, Heaney, RP, Kalkwarf, HJ, Pitkin, RM. The role of calcium in health and disease. Am J Obstet Gynecol 1999;181:1560-9.
11.Boonen S, Dejaeger E, Vanderschueren D, Venken K, Bogaerts A, Verschueren S, Milisen K. Osteoporosis and osteoporotic fracture occurrence and prevention in the elderly: a geriatric perspective. Best Pract Res Clin Endocrinol Metab. 2008;22:765-85.
12.Lanham-New SA. Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proc Nutr Soc. 2008;67:163-76.
13.Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract. 2007 ;22:286-96.
14.Reid IR, Bolland MJ, Grey A. Effect of calcium supplementation on hip fractures. Osteoporos Int. 2008;19:1119-23.
15.Storm D, Eslin R, Porter E. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. J Clin Endocrinol Metab 1998;83:3817-25.
16.Dawson-Hughes B, Dallal GE, Krall EA. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990;323:878-83.
17.Recker RR, Hinders SK, Davies M. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 1996;11:1961-6.
18.Prince RL, Devine A, Dhaliwal SS, Dick IM. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med 2006;166:869-75.
19.Douglas P. Kiel. Preventing Nonvertebral Fractures with Vitamin D3 and Calcium ACP Journal Club. 1993；118:66.
20.Douglas C. Bauer. Calcium and vitamin D reduced nonvertebral fractures and bone loss ACP Journal Club. 1998；128:47.
21.Meta-analysis: Several strategies prevent falls and subsequent injury in older persons Evidence-Based Medicine. 1996；1:169-76.
22.Lau EM, Woo J, Leung PC, Swaminathan R, Leung D. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporosis International. 1992；2:168-73.
23.Prince RL, Devine A, Dhaliwal SS, Dick IM. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med. 2006;166:869-75.
24.Daly RM, Brown M, Bass S. Calcium- and vitamin D3-fortified milk reduces bone loss at clinically relevant skeletal sites in older men: a 2-year randomized controlled trial. J Bone Miner Res 2006; 21:397-405.
25.Grant AM, Avenell A, Campbell MK. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005;365:1621-8.
26.Bischoff-Ferrari HA, Rees JR, Grau MV, Barry E, Gui J, Baron JA. Effect of calcium supplementation on fracture risk: a double-blind randomized controlled trial. Am J Clin Nutr. 2008 ;87:1945-51.
27.Meier C, Woitge HW, Witte K. Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open-label prospective trial. J Bone Miner Res 2004; 19:1221-30.
28.Jackson RD, LaCroix AZ, Gass M. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354:669-83.
29.Dawson-Hughes B, Dallal GE, Krall EA. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990; 323:878-83.
30.Reid IR, Ames RW, Evans MC. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 1993; 328:460-4.
31.Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337:670-6.
32.Peacock M, Liu G, Carey M. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. J Clin Endocrinol Metab 2000; 85:3011-9.
33.Reid IR, Mason B, Horne A. Randomized controlled trial of calcium in healthy older women. Am J Med 2006; 119:777-85.
34.Reid IR, Ames R, Mason B. Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic,older men. Arch Intern Med 2008; 168:2276-82.
35.Wu K, Willett WC, Fuchs CS. Calcium intake and risk of colon cancer in women and men. J Natl Cancer Inst 2002; 94:437-46.
36.Cho E, Smith-Warner SA, Spiegelman D. Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst 2004; 96:1015-22.
37.Park SY, Murphy SP, Wilkens LR, Nomura AM, Henderson BE, Kolonel LN. Calcium and vitamin D intake and risk of colorectal cancer: the Multiethnic Cohort Study. Am J Epidemiol. 2007 ;165:784-93.
38.Wactawski-Wende J, Kotchen JM, Anderson GL. Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med 2006; 354:684-96.
39.Grau MV, Baron JA, Sandler RS, Haile RW, Beach ML, Church TR, Heber D. Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst. 2003 ;95:1765-71.
40.Wallace K, Baron JA, Cole BF, Sandler RS, Karagas MR, Beach MA, Haile RW, Burke CA, Pearson LH, Mandel JS, Rothstein R, Snover DC. Effect of calcium supplementation on the risk of large bowel polyps. J Natl Cancer Inst. 2004 ;96:921-5.
41.Shaukat A, Scouras N, Schunemann HJ. Role of supplemental calcium in the recurrence of colorectal adenomas: a metaanalysis of randomized controlled trials. Am J Gastroenterol 2005; 100:390-4.
42.Grau MV, Baron JA, Sandler RS, Wallace K, Haile RW, Church TR, Beck GJ, Summers RW, Barry EL, Cole BF, Snover DC, Rothstein R, Mandel JS. Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial. J Natl Cancer Inst. 2007 ;99:129-36.
43.Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 2000; 95:3053-63.
44.Power ML, Heaney RP, Kalkwarf HJ, Pitkin RM. The role of calcium in health and disease. Am J Obstet Gynecol 1999; 181:1560-9.
45.Griffith LE, Guyatt GH, Cook RJ. The influence of dietary and nondietary calcium supplementation on blood pressure. Am J Hypertens 1999; 12:84-92.
46.Bostick RM, Fosdick L, Grandits GA, Grambsch P. Effect of calcium supplementation on serum cholesterol and blood pressure. A randomized, double-blind, placebo-controlled, clinical trial. Arch Fam Med 2000; 9:31-8.
47.Sacks FM, Willett WC, Smith A. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertension 1998; 31:131-8.
48.Reid IR, Horne A, Mason B. Effects of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial. J Clin Endocrinol Metab 2005; 90:3824-9.
49.Dawson-Hughes B, Harris SS, Dallal GE, Lancaster DR, Zhou Q. Calcium supplement and bone medication use in a US Medicare health maintenance organization. Osteoporosis International. 2002 13:657-62.
50.Vatanparast H, Dolega-Cieszkowski JH, Whiting SJ. Many adult Canadians are not meeting current calcium recommendations from food and supplement intake. Appl Physiol Nutr Metab. 2009 ;34:191-6.
51.Bruyere O, De Cock C, Mottet C, Neuprez A, Malaise O, Reginster JY. Low dietary calcium in European postmenopausal osteoporotic women. Public Health Nutr. 2009 ;12:111-4.
52.Chen SY, Lin JR, Kao MD, Hang CM. The usage of dietary supplements among the elderly individuals in Taiwan. Asia Pac J Clin Nutr. 2005;14:230-7.
53.Chang CH, Chiang TL. Vitamin/calcium supplement use in Taiwan: findings from the 1994 National Health Interview Survey. Kaohsiung J Med Sci. 2002 ;18:171-81.
54.Rakel RE： Textbook of Family Practice. 5th ed. Phildelphida：WB Saunders Companh, 1995.