A report by the International Osteoporosis Foundation (IOF) shows alarming projections and reveals the poor state of post-fracture care in the Russian Federation and many other countries in the region. Osteoporosis, a disease of the bone which leaves people at increased risk of fracture, is most common in the older population. Yet, despite the major public health burden of osteoporosis-related fractures, the IOF submits that the disease suffers from severe under recognition. While low levels of calcium and vitamin D intake impact negatively on bone health, the IOF report observes that the average daily calcium intake in nearly all countries outlined in the report falls far below the FAO/WHO recommendations. In addition, the majority of populations in the region suffer from severe vitamin D insufficiency. Although older people who sustain a hip fracture are at increased risk of death and suffer long term disability throughout the world, the report indicates that this problem is far more severe in the Russia Federation and in many other countries of the region. There is high mortality rate after a hip fracture, reaching up to 45-52% during the first year after fracture in some Russian cities. IOF Chief Operating Officer Judy Stenmark states that: "Wider and more equitable access to diagnostic tests and appropriate medication are required to stem the growing tide of fractures in the region."