A systematic review of the effectiveness of lifestyle interventions for improving bone health in women at high risk of osteoporosis.

Abstract

Osteoporosis is a disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and a consequent increase in fracture risk, especially among postmenopausal women. Management strategies for osteoporosis focus on reducing modifiable risk factors such as poor nutrition, insufficient physical activity, smoking, and heavy alcohol consumption. The aim of this systematic review is to examine the effects of lifestyle interventions on bone health in women at high risk of osteoporosis INCLUSION CRITERIA: We included randomised controlled trials that examined the effectiveness of lifestyle interventions. The participants consisted of adult women who have had osteoporosis, osteopenia, or were at high-risk of developing osteoporosis. Lifestyle interventions included exercise, diet, and education. The outcomes of bone health were bone mineral density, event (fall, fracture), balance, and quality of life. We conducted a comprehensive search of the published literature using a three-phase approach in English and Korean languages up until September 2009. Two independent reviewers appraised all reports using standardised critical appraisal tools from the Joanna Briggs Institute that were specific to experimental research designs. Quantitative data was extracted from papers using the standardised data extraction tool from Joanna Briggs Institute. Quantitative papers were pooled wherever possible to a statistical meta-analysis using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. The search identified 700 unique studies; we appraised 28 studies and included a total of 25 randomised controlled trials in the final study; three studies were excluded because of poor methodological quality. Strength exercises had a positive effect on fracture. Aerobic exercises had a positive impact on lumbar bone mineral density, fall, and balance. Soy protein supplementation was effective for improving lumbar bone mineral density while vitamin K supplementation had a positive effect on of femur bone mineral density. Calcium supplementation had a positive impact on femur and lumbar bone mineral density. The combination of exercise, calcium, and vitamin D supplementation was effective for improving lumbar bone mineral density, risk of fall, and balance. Self-management programs for better bone health had a positive effect on balance and quality of life. The results indicate that lifestyle interventions including exercise and taking daily calcium and vitamin D supplementation are beneficial for improving bone health in women at high risk of osteoporosis. However, additional carefully designed randomised controlled trials studies with larger patient populations are needed to more precisely identify the effects of intervention. It is recommended to engage in a combination of regular exercise and daily calcium and vitamin D supplementation with consideration of age, menopausal status, and bone mineral density for women with a high risk of developing osteoporosis. Effects of combined intervention of lifestyle components should be evaluated in large, carefully designed randomised controlled trials.