Twenty-four RCTs were included for review (at least 6,345 participants). Nine trials were level 1+ (RCTs with a low risk of bias) and 15 were level 1- (RCTs with a high risk of bias). Methodological weaknesses were randomisation, lack of power calculations and short follow-up.
Quality of life (13 studies, n=2,110): Eight out of 13 non-pharmacological interventions showed significant small to large benefits on quality of life in post menopausal women with osteoporosis, osteopenia or fractures (Cohen's d from 0.24 to 1.79, p<0.0.05 to p<0.001).
Changes in bone mineral density (five studies, n=561): The review authors reported that one study found spinal bone mineral density was higher in the intervention group (Cohen's d = -0.02, p<0.031) for a physical activity intervention. One study showed significant benefits for nutrition education (p<0.01) on bone mineral density. The other studies had non-significant results or results that favoured control interventions.
Compliance and persistence (four studies, n=2,888): Two out of three studies that measured compliance reported significant benefits of information, monitoring or feedback on bone turnover markers compared to usual care (p=0.010 and p=0.05). One out of three studies showed significantly greater persistence to medication with nurse monitoring usual care (p=0.06).
Knowledge (six studies, n=1,824): Two out of six studies showed significant benefits on knowledge of osteoporosis with an information and follow-up intervention (Cohen's d = 0.30, p=0.015) and education group (p<0.001).
Lifestyle modifications (five studies, n=1,417): Four out of five studies showed significant increases in calcium intake in intervention groups that received education, counselling or osteoporosis status feedback (p values ranged from p<0.01 to p<0.05). One out of four studies showed an improvement in frequency of exercise with counseling interventions compared to control groups. No studies showed significant benefits on smoking or alcohol use.