Tailored Interventions to Enhance Osteoporosis Prevention in Women Structural Model for Osteoporosis Preventing Behavior in Postmenopausal Women CAUSAL ANALYSIS OF EXERCISE AND CALCIUM INTAKE BEHAVIORS FOR OSTEOPOROSIS PREVENTION AMONG YOUNG WOMEN IN THAILAND Osteoporosis prevention in young women. What is the impact of osteoporosis education and bone mineral density testing for postmenopausal women in a managed care setting? YOUTH: decisions and challenges in designing an osteoporosis prevention intervention for teen girls. Impact of preventive osteoporosis education on patient behavior: immediate and 3-month follow-up Social support, knowledge, and self-efficacy as correlates of osteoporosis preventive behaviors among preadolescent females. How do women change osteoporosis-preventive behaviours in their children? The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260] Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial. A randomized controlled trial of mailed osteoporosis education to older adults Effects of Educational Materials concerning Osteoporosis on Women's Knowledge, Beliefs, and Behavior [Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Facilitative Strategies, Psychological Factors, and Strength/Weight Training Behaviors in Breast Cancer Survivors Who Are at Risk for Osteoporosis Effectiveness of Community Intervention in Improving Bone Health Behaviors in Older Adults Youth: a health plan-based lifestyle intervention increases bone mineral density in adolescent girls.
PURPOSE The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis , health beliefs , or osteoporosis-prevention behaviors in postmenopausal women 50–65 years of age , 6 months after the intervention . METHOD The design for this pilot study was a two group quasi-experimental design . The treatment group received a tailored intervention ; the control group did not . Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry . The tailored intervention was design ed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis question naire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake , exercise , smoking , and alcohol use . A written mailed copy of the intervention followed the telephone interview . Six months after the intervention , the women were mailed another osteoporosis question naire to determine if the tailored intervention made a difference in the outcome variables . SAMPLE A total 124 women between the ages of 50 and 65 ( 101 control , 23 treatment ) comprised the sample . RESULTS There was no difference in knowledge between groups . On the average , there were significantly more perceived barriers to calcium in the tailored group ( mean = 13.48 ) than in the nontailored group ( mean = 11.55 ) ( t = 2.147 ; df = 122 ; p = .034 ) . There were significantly more perceived barriers to exercise in the tailored group ( mean = 14.39 ) than in the nontailored group ( mean = 12.21 ) ( t = .144 ; df = 122 ; p = .034 ) . Daily calcium intake increased in both the tailored and the nontailored groups . The tailored intervention increased women 's daily calcium intake from 614.28 to 1039.10 mg ( t = −2.896 ; df = 22 ; p = .008 ) . The nontailored group daily calcium intake increased from 587.91 to 916.30 mg ( t = −3.541 ; df = 100 ; p = .001 ) ; there was no significant difference between the groups . Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise . CONCLUSION Tailored interventions  increased women 's perceived barriers to calcium and exercise . Both groups increased calcium intake . The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study . This important intervention has implication s for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis Background : Osteoporosis prevention behaviors ( OPBs ) can prevent and delay bone deterioration ; dual-energy X-ray absorptiometry ( DXA ) scan can identify osteoporosis and provide personal osteoporosis risk information that may promote prevention behaviors . Objectives : This study was design ed to estimate relationships between receiving personal knowledge of bone mineral density ( gained through DXA scan ) , general knowledge of osteoporosis , health beliefs , and the two OPBs of calcium intake and weight-bearing exercise in healthy postmenopausal women 50 to 65 years . Methods : In this longitudinal , r and omized clinical trial ( including covariates ) , receipt of personal DXA information was manipulated by r and om assignment to the experimental or control group . The remaining antecedent and outcome variable measures were collected by question naire at three time points ( initial [ T1 ; pre-DXA ] , 6 months [ T2 ] , 12 months [ T3 ] ) and by bone density assessment from 203 women over an 18-month period in 2001 - 2003 . Results : The experimental manipulation ( DXA results ) had a direct positive effect ( & bgr ; = .23 , p < .05 ) on calcium intake at T2 , and indirectly at T3 through T2 . Women in the experimental group who were informed they had osteopenia or osteoporosis had a greater T1-T2 change in daily calcium intake than those with normal bone density ( & bgr ; = .23 , p < .05 ) . However , providing DXA results did not relate to change in exercise . Health beliefs and general osteoporosis knowledge predicted initial calcium and exercise levels ; there was tentative evidence that susceptibility beliefs partially mediate between DXA results and change in calcium intake . Discussion : Personal knowledge of DXA results was related significantly to increases in calcium intake in postmenopausal women , but not to exercise . Directions for further study are discussed The goal of health education is to provide information to affect attitudes , beliefs , and intentions for behavior change . However , little is known about the effects of changes in knowledge on behaviors for osteoporosis prevention . Our objective is to develop and test theoretical models of the effects of knowledge , attitude , and self-efficacy on exercise and calcium intake among young women before and after an intervention program .  First , we hypothesized that knowledge would positively predict attitude , self-efficacy , calcium intake , and exercise .  Second , attitude would positively predict self-efficacy , calcium intake , and exercise .  Third , self-efficacy would positively predict calcium intake and exercise  . Fourth , attitude and self-efficacy would mediate the effect of knowledge on calcium intake and exercise . At the beginning and end of the study , participants in the control group and intervention group completed the  osteoporosis knowledge test , the osteoporosis health belief scale , the osteoporosis self-efficacy scale , a self-report for food records , and exercise .  The causal model was examined as a result of our study . After the intervention program ,  calcium intake and exercise  were predicted by knowledge when mediated by attitudes and self-efficacy . The final model accounted for 30 % and 45 % of the variance in calcium intake and exercise , respectively . We conclude that interventions to enhance young women 's  knowledge and self-efficacy may result in increased calcium intake and exercise PURPOSE To assess whether young women who participate in an osteoporosis prevention program based on the Health Belief ( Rosenstock , 1966 ) and Self-Efficacy Models ( B and ura , 1977 ) demonstrate higher levels of knowledge regarding osteoporosis prevention than young women who do not participate in such a program . DESIGN A classic experimental design with one treatment group and one control group was used to test the efficacy of the osteoporosis prevention program . Pretest data on knowledge , health belief attitudes ( 7 subscales ) , and self-efficacy ( 2 subscales ) were collected in the treatment and control groups . SAMPLE A convenience sample of 31 young college women were r and omly assigned to an experimental group or to a control group to receive an osteoporosis prevention program . METHOD Subjects in the experimental and control groups completed the  Osteoporosis Knowledge Test , the Osteoporosis Health Belief Scale  , and the Osteoporosis Self-Efficacy Scale  ( Kim et al. , 1991 ) at two times . The experimental group received an osteoporosis prevention program . MAIN RESEARCH CLASSIFICATIONS Osteoporosis , Health Belief , Self-Efficacy , Women 's Health . FINDINGS Subjects in the experimental group had significantly higher knowledge and health belief scores after receiving the intervention than their pretest scores while subjects in the control group had no change in scores . CONCLUSION The osteoporosis program was effective in increasing awareness of osteoporosis prevention in this group of young women . IMPLICATION S FOR NURSING RESEARCH The results may be useful for developing young women 's awareness and knowledge of osteoporosis prevention . Future research could include developing osteoporosis prevention programs at an earlier age when girls are in grade school and junior high school . Teaching health promotion strategies for bone health is essential to all women across the life span Objective To assess whether osteoporosis education , with and without bone mineral density ( BMD ) testing , increases the initiation of lifestyle changes and pharmaceutical treatment to prevent osteoporosis . Design A total of 508 women , aged 54–65 , from a large managed care organization who were not on osteoporosis prevention therapy participated in an intervention study . Participants were r and omly assigned to either an education class on osteoporosis ( n = 301 ) or education plus BMD ( n = 207 ) . A control group of 187 women receiving no intervention were also surveyed to serve as comparison . Group differences and differences based on BMD test result were compared 6 months after education regarding self-reported changes in health behaviors using & khgr;2 tests and logistic regression analyses . Results Of the 508 intervention participants , 455 ( 90 % ) responded to the follow-up survey . Initiation of hormone replacement therapy was reported by 9 % , with 5 % reporting starting alendronate . More than half reported changes in diet , exercise , or calcium intake . Forty-three percent increased their vitamin D intake . There were no significant group differences in behavior except with regard to pharmaceutical therapy ; subjects with education plus BMD were three times more likely than those receiving education only to report starting hormone replacement therapy ( p = 0.004 ) . Low BMD scores were associated with increasing vitamin D intake ( p = 0.03 ) and starting medication ( p = 0.001 ) . Women in the intervention groups were significantly more likely to report modifying their diet ( p < 0.001 ) , calcium ( p < 0.01 ) , and vitamin D intake ( p < 0.0001 ) than women in the control group , not exposed to education . Conclusion Education regarding osteoporosis prevention seems to encourage women to make lifestyle changes . The inclusion of BMD testing enhances the likelihood that women will consider pharmaceutical therapy BACKGROUND This paper describes decisions about the experimental design for the Youth , Osteoporosis , and Underst and ing Total Health Project ( YOUTH ) , a trial design ed to test the efficacy of a health plan-based lifestyle intervention for increasing bone mineral density among adolescent women 14 to 16 years of age . METHODS This r and omized controlled trial recruited adolescent women who were at higher risk for developing osteoporosis ( body mass index 16 - 23 ) from a large HMO in the Pacific Northwest . The intervention focused on improving diet ( high calcium foods , fruits , and vegetables ) and increasing physical activity ( high impact and spinal motion ) . The intervention included both group and individual activities . The primary endpoint in the study was total bone mineral density as measured by dual-energy X-ray absorptiometry ( DEXA ) . RESULTS Baseline data were collected on the trial cohort of 228 adolescent women and their families . This paper discusses how research ers met the following challenges in design ing and implementing the trial : determining appropriate dietary and exercise targets to affect bone mineral density in adolescents ; choosing suitable assessment s ; and developing an intervention well suited for implementation in a non-school ( health plan ) setting . We also discuss the rationale for the specific study population chosen ( females , younger adolescents ) . CONCLUSIONS The YOUTH project is one of very few preventive research interventions with adolescents conducted in a health plan setting . Many of the recruitment and intervention strategies used in this trial may be appropriate for adoption in other health plan-based prevention studies Objective To evaluate the effectiveness of an educational video on osteoporosis at increasing knowledge and preventive health behaviors . Design A total of 195 women between 35 and 80 years of age without documented osteopenia or osteoporosis , who presented for a gynecological examination in an outpatient setting , were enrolled . Of this number , 98 women were r and omly assigned to the intervention group that viewed the video before their office visit , and 97 women were assigned to a control group and saw their physician in a routine manner . After their visit , all participants answered a question naire that assessed their knowledge of osteoporosis and baseline health-related behaviors . Three months later , a follow-up question naire was mailed to participants , eliciting whether preventive behavior had commenced . Frequencies were compared using the Fisher exact test ( 2-tailed ) . Continuous variables were analyzed using the Student 's t test . Results The two groups had no statistically significant differences in demographics . The intervention group scored a mean of 92 % compared with a mean of 80 % in the control group on the initial osteoporosis assessment question naire ( P < 0.001 ) . The 3-month follow-up question naire demonstrated that significantly more women in the intervention group started taking calcium supplements  ( 26.5 % v 4.9 % ; P < 0.001 ) , started taking vitamin D supplements  ( 20.6 % v 6.6 % ; P = 0.02 ) , started a  program of weight-bearing exercise  ( 13.3 % v 1.7 % ; P = 0.03 ) , and started  hormone therapy ( 8 % v 1 % ; P = 0.04 ) . Conclusion The use of an educational video on osteoporosis seems to improve patient knowledge and may positively impact health-related behaviors OBJECTIVE To develop and test a model based on B and ura 's social cognitive theory to predict healthy lifestyle behaviors for the prevention of osteoporosis . METHODS Participants were 354 girls , ages 8 - 11 years , recruited from area Girl Scout troops . Baseline data from a r and omized trial of behavioral interventions are presented . Measures of social support , knowledge , self-efficacy , dietary calcium intake , and weight-bearing physical activity ( WBPA ) were obtained via interviews and self-administered question naires . RESULTS A structural equation model was tested and fit the data well . Family social support , perceived self-efficacy for eating a calcium-rich diet , and knowledge of WBPA significantly predicted calcium intake . Friend and family support for exercise predicted WBPA . Self-efficacy partially mediated the relationship between family support and calcium intake , as confirmed by Holmbeck 's post-hoc probing strategy ( 2002 ) . CONCLUSIONS Suggestions are made for primary prevention interventions such as parent and peer involvement , health education , and problem-solving training Objective : We have reported that a lifestyle intervention with mothers  improved calcium intake and physical activity in both mothers and their children . In this study , we aim ed to describe the strategies and approaches used by these mothers to improve their children 's calcium intake and physical activity . Design : A qualitative study using semistructured interviews . Setting : Population -based convenience sample .Subjects : A sub sample of 39 mothers were taken from a population -based r and om sample of 354 mothers who had participated in the original osteoporosis-prevention trial . Results : Mothers described specific dietary changes they made to increase their children 's calcium intake . They also described strategies for improving calcium intake and physical activity such as raising awareness of the importance of calcium ; ensuring calcium-rich foods were accessible ; assessing their children 's likes and dislikes and working within these ; role modelling ; information provision ; taking a balanced approach to attempting behaviour change ; and encouraging activities that they could do with their children . Mothers emphasized the general importance of a balanced diet and lifestyle , rather than just focussing on lifestyle factors specific to osteoporosis prevention . Conclusion : Even without specific guidance , mothers are adept at developing strategies to apply to changing lifestyle behaviours in their children and identifying barriers to change . These results provide information , which could be incorporated into future interventions for lifestyle change in children and also provide further support for considering parent-focused approaches to this problem Background Limited information is available on ways to influence osteoporosis risk in premenopausal women . This study tested four hypotheses regarding the effects of individualized bone density ( BMD ) feedback and different educational interventions on osteoporosis preventive behavior and BMD in pre-menopausal women , namely : that women are more likely to change calcium intake and physical activity if their BMD is low ; that group education will be more efficacious at changing behavior than an information leaflet ; that BMD feedback and group education have independent effects on behavior and BMD ; and , that women who improve their physical activity or calcium intake will have a change in bone mass over 2 years that is better than those who do not alter their behavior . Methods We performed a 2-year r and omized controlled trial of BMD feedback according to T-score and either an osteoporosis information leaflet or small group education in a population -based r and om sample of 470 healthy women aged 25–44 years ( response rate 64 % ) . Main outcome measures were dietary calcium intake , calcium supplement use , smoking behavior , physical activity , endurance fitness , lower limb strength and BMD . We used paired t-tests , one-way ANOVA and linear regression techniques for data analysis . Results Women who had feedback of low BMD had a greater increase in femoral neck BMD than those with normal BMD ( 1.6 % p.a . vs. 0.7 % p.a . , p = 0.0001 ) , but there was no difference in lumbar spine BMD change between these groups ( 0.1 % p.a . vs. 0.08 % p.a . , p = 0.9 ) . Both educational interventions had similar increases in femoral neck BMD ( Leaflet = + 1.0 % p.a . , Osteoporosis self-management course = + 1.3 % p.a . , p = 0.4 ) . Femoral neck BMD change was only significantly associated with starting calcium supplements ( 1.3 % p.a , 95%CI + 0.49 , + 2.17 ) and persistent self-reported change in physical activity levels ( 0.7 % p.a . , 95%CI + 0.22 , + 1.22 ) . Conclusion Individualized BMD feedback combined with a minimal educational intervention is effective at increasing hip but not spine bone density in premenopausal women . The changes in behavior through which this was mediated are potentially important in the prevention of other diseases , thus measuring BMD at a young age may have substantial public health benefits , particularly if these changes are sustained In this r and omized controlled trial , we examined the effects of a 3-month therapeutic lifestyle modification ( TLM ) intervention on knowledge , self-efficacy , and health behaviors related to bone health in postmenopausal women in rural Korea . Forty-one women ages 45 or older were r and omly assigned to either the intervention ( n = 21 ) or control ( n = 20 ) group . The intervention group completed a 12-week , 24-session TLM program of individualized health monitoring , group health education , exercise , and calcium-vitamin D supplementation . Compared with the control group , the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks , providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis Introduction Osteoporosis represents a growing public health concern ; however , current rates of management are sub-optimal . The aim of our study was to assess , in a r and omized controlled trial , the effect of a mailed educational intervention on older adults ’ knowledge , attitudes , and preventive behaviors regarding osteoporosis . The setting was a large publicly funded state pharmacy benefits program . The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people . Methods All women aged over 65 years , and all men and women with a history of fracture or long-term oral use of glucocorticoid , were included . Approximately half of the participants ( intervention group ) were r and omly selected to receive three mailings aim ed at improving knowledge of osteoporosis and enhancing preventive activities , such as using calcium and vitamin D , reducing fall risks in the home , obtaining a bone mineral density ( BMD ) test , and taking medications when necessary . The other participants did not receive the intervention mailings and served as controls . We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge , attitudes , self-efficacy ( confidence in one ’s ability to perform specific activities ) , and behavior regarding osteoporosis prevention and treatment . Six hundred r and omly selected participants in the intervention group and an equal number in the control group were invited to participate . Results Twenty-six had died and 636 of the remaining 1,185 ( 54 % ) completed the survey . Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors . All scales had good reliability ( all Cronbach ’s alphas > 0.65 ) . Knowledge of osteoporosis was generally very good and did not differ between intervention ( mean = 65 % correct responses ) and control subjects ( mean = 67 % correct ; P=0.4 ) . Perceived susceptibility to osteoporosis was relatively high and similar across groups ( P=0.4 ) . Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention ( mean = 4.3 on a 0–5 scale ) and control ( mean = 4.2 , P=0.03 ) groups . On average , subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group ( P=0.5 ) . Conclusions Compared with the controls , a mailed educational intervention for osteoporosis was not associated with better knowledge , higher perceived susceptibility , or performance of preventive measures among the at-risk older adults that we studied . The intervention group demonstrated a small increase in self-efficacy . More intensive patient interventions or intervention aim ed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures Purpose . This study examined the effects of brief written educational material s on osteoporosis-related knowledge , beliefs , and behaviors . The study also examined whether observed effects varied as a function of one 's stage in the pre caution adoption process . Design . The study used an experimental research design . Setting . Participants were identified from North Carolina driver 's license records . Subjects . Of the 1476 women in the initial sample , 536 ( 36.3 % ) enrolled in the study and 307 completed all follow-up assessment s. Intervention . Participants were r and omly assigned to one of four groups . One group received an information packet containing general information about osteoporosis . One group received an action plan packet containing instructions on how to increase one 's level of exercise and calcium intake .  One group received both packets . The final group received neither packet . Measures . Primary study variables were beliefs related to osteoporosis , calcium , and exercise ; osteoporosis knowledge ; calcium and exercise stage ; calcium intake ; and exercise level . Results . Overall , receipt of the information packet was associated with changes in knowledge and beliefs ( F[18,283 ] = 2.11 , p < .01 ) irrespective of participants ' stage of change . No effects on behavior were observed . Conclusions . These findings suggest that brief written educational material s can facilitate knowledge and belief change but that they do not promote behavior change . The generalizability of these findings is limited by the low study response rate One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life INTRODUCTION / PURPOSE Many women who have been treated for breast cancer are at increased risk for bone loss .  Strength/weight training exercises ( SWTE ) may be effective in preventing bone loss and subsequent fractures . The purpose of this exploratory study was to examine psychological factors ( self-efficacy , perceived benefits vs. costs , and processes of change ) and their relationship to adherence and progression in use of heavier weights in breast cancer survivors ( BCS ) . SAMPLE Twenty-three BCS with mean age of 54.8 ( SD = 7.2 ) years , mean time since menopause of 5.8 ( SD = 5.3 ) years , and mean time since cancer treatment completion of 4.1 ( SD = 3.0 ) years . METHODS Exploratory one-group design with multicomponent intervention inclusive of medication , calcium with vitamin D supplement , and home-based SWTE with facilitative strategies by nurses and personal exercise trainers based on the Transtheoretical Model . FINDINGS BCS doing SWTE for 6 months : ( 1 ) maintain a high level of self-efficacy , ( 2 ) perceive increasing benefits for 6 months , ( 3 ) use cognitive processes more frequently than behavioral ones , ( 4 ) were highly adherent to the SWTE , and ( 5 ) demonstrate that behavioral processes are positively related to increase in pounds lifted . DISCUSSION / CLINICAL IMPLICATION S Larger r and omized trials studies are needed to determine the most effective strategies for assuring adherence to and progression of SWTE in this population at risk for osteoporosis An 8-week , bone-health community program addressed risks/lifestyle changes within the Health Belief Model and Theory of Reasoned Action frameworks in a r and omized format ( treatment group n = 35 ; control group n = 34 ) . Median week 1 values for calcium ( control , 963 mg ; treatment , 1023 mg ) and vitamin D ( 81 IU both groups ) were below recommendations , increasing throughout the program for both control ( 1023 mg calcium , 128 IU vitamin D ) and treatment ( 1005 mg calcium , 122 IU vitamin D ) groups . There was limited response to the exercise outcome variables , with many not participating in that section of the program . Psychosocial variables were positive for both control and treatment groups at week 1 , with no significant difference at postintervention . Regression analysis indicated that those with a positive attitude about calcium intake and belief that they could choose calcium-fortified foods were more likely to have higher calcium intake . Intention to exercise was modified by peer and family support . Community-based programs can translate and use clinical trial key topics and outcomes , but participation bias makes impact results difficult to interpret the effectiveness of the program OBJECTIVE To test the efficacy of a health plan-based lifestyle intervention to increase bone mineral density  in adolescent girls . DESIGN Two-year r and omized , controlled trial . SETTING Large health maintenance organization . PARTICIPANTS Girls 14 to 16 years old with body mass index below the national median .  Intervention Behavioral intervention ( bimonthly group meetings , quarterly coaching telephone calls , and weekly self-monitoring ) design ed to improve diet and increase physical activity . MAIN OUTCOME MEASURES Total bone mineral density was measured by dual-energy x-ray absorptiometry . Behavioral outcomes included intake of calcium , vitamin D , soda , and fruits and vegetables ; high-impact and strength-training physical activity ; measures of strength and fitness ; and biomarkers ( osteocalcin and naltrexone ) . RESULTS Compared with control subjects , girls in the intervention group had significantly higher bone mineral density in the spine and trochanter regions during the first study year , which was maintained during the second study year . The naltrexone biomarker demonstrated a greater relative decrease in the intervention group compared with the control group , with nonsignificant changes in osteocalcin consistent with more bone building in the intervention group . Participants in the intervention group reported significantly greater consumption of calcium in both study years , vitamin D in the first year , and fruits and vegetables in both years . We found no effect on soda consumption or target exercise rates . CONCLUSIONS A comprehensive health care-based lifestyle intervention can effectively improve dietary intake and increase bone mineral gains in adolescent girls . To our knowledge , this study is the first to significantly improve bone mass in adolescent girls in a non-school-based intervention . Trial Registration Clinical Trials.gov Identifier : NCT00067600
Results indicate health behavior change is more likely to occur when patient-centered interventions design ed to increase knowledge and health beliefs , skills and abilities  , and  social facilitation  are delivered over time .
Little is known about the dimensions of osteoporosis prevention programs essential to changing health behaviors .
The purpose of this review was to determine the impact of select characteristics of structured osteoporosis prevention programs on calcium intake in women .