Nine studies were included in the review (n=2,217 participants): four RCTs, two quasi-experimental trials and three uncontrolled descriptive longitudinal studies. All studies were reported to score well for validity. Some studies reported evidence of selection bias and detection bias (self-report measurement). None of the subjects or investigators were blinded for RCTs.
All four RCTs reported improved bone-healthy behaviours in the intervention groups post intervention compared to control groups. Behaviours included increased soy foods, milk, calcium, vitamin D intake/sunlight exposure and exercise (two RCTs) and commencement of hormone replacement therapy and increased vitamin D intake (one RCT). One RCT found no significant differences between groups for initiation or persistence of drug treatment, although there was evidence of increased calcium intake and exercise frequency.
One quasi-experimental study reported a statistically significant increase in dietary calcium intake (p<0.04) and use of hormone replacement therapy (p<0.32) six months post intervention for an educational intervention led by a multidisciplinary team compared to control. There were no differences in amount of exercise, caffeine use, alcohol intake, smoking, knowledge scores and intake of calcium and/or vitamin D supplements. One quasi-experimental reported significant increases in perceived barriers to calcium intake and significant decreases in exercise frequency in a tailored nursing intervention group compared to control.
Three uncontrolled studies reported improvements post intervention. One study reported an increase in osteoporosis knowledge, fall prevention behaviours and exercise frequency. Increased intake of calcium rich foods and use of calcium supplements were not sustained at 9.5 months follow-up. One uncontrolled study reported improvement in calcium intake, exercise frequency and beginning recommended medication six months post intervention, but no statistical analysis was conducted. One uncontrolled study reported increased intake of calcium/vitamin D together with exercise frequency and gains in strength, balance, flexibility and adherence after an intervention led by a multidisciplinary team at six months post intervention and at two years post intervention reported continued statistically significant improvement for exercise frequency and calcium/vitamin D intake and improvements in bone density scores for the spine.