Table 5.

Education approaches to improve knowledge, beliefs or practice of adolescents and young adults regarding osteoporosis.

Studies	Design	Location	Setting	Population	Intervention Descriptions	Outcomes
Educational intervention to modify knowledge, attitude and practices towards osteoporosis
Schoenfeld et al. (2010) [58]	Tailored Web-Education System (TWEEDS) Tool and Web Site Development	New York	School	n = 89, age 13 to 17 years, mean age 15.7 years	Online pre- and postintervention surveys (45 min) evaluated participants’ pre- and postintervention osteoporosis knowledge, attitudes, preventive practices, and postintervention intent to change healthy bone practices. Participants completed the Web-based program that provided detailed information about osteoporosis, and healthy bone practices, immediately after completing the pre-test and just prior to completing the post-test	Adolescents changed their perception regarding the disease seriousness and considered adopting osteoporosis prevention practices
Sanaeinasab et al. (2013) [59]	Quasi-experimental study	Female students resided in a town near Tehran	School	n = 45, 15 to 16 years’ old	Three group sessions of 60 min per week educational programme based on the Health Belief Model. Lecture, question and answer, brain-storming, group discussion with pamphlets about the role of nutrition and physical activity in disease prevention and a booklet on osteoporosis.	Before intervention, only 2.2% of the subjects have good knowledge regarding osteoporosis, it increases to 66.7% after intervention Mean scores of some Health Belief Model structures (perceived susceptibility towards osteoporosis, perceived barriers of physical activity, self-efficacy of calcium and physical activity) changed significantly after the intervention (p < 0.05) Post-intervention, physical activity increased (p = 0.041) but calcium intake did not.
Takahata (2018) [60]	Circuit exercise training	Baika Women’s University, Osaka, Japan	School	n = 41, mean age 18.5 ± 0.6 years	Circuit training which involves performing both anaerobic and aerobic exercise continuously for 3 months (5 mins × 3 sets =15 mins, do the exercise at least 3 days in a week)	Broadband ultrasound attenuation of the calcaneus was higher 2 months later (p = 0.033) as well as 3 months later (p = 0.036), and the speed of sound of the calcaneus was higher 3 months later (p = 0.018) in the exercising group Muscle mass was strongly positively correlated with the calcaneus QUS-SOS.
Zhang et al. (2012) [61]	One group quasi-experimental study	Shaanxi, Northwest China	Nursing school	n = 256, mean age 18.80 ± 1.55 years	2.5-h lecture followed by 30 min open discussion, and 20 min for questions and answers. The lecturer summarized the content matter delivered during the program following the question-and-answer period to reinforce teaching and learning objectives. The educational program addressed the definition, prevalence, and etiology of osteoporosis; risk factor identification; physical signs of the disease; preventive and diagnostic measures; and treatment	Intervention successfully increased the baseline osteoporosis knowledge score two weeks after the educational in-service The educational program significantly increased total osteoporosis health beliefs and the subscales, except for the perceived barriers to exercise and calcium intake
Educational intervention to improve Calcium and/or Vitamin D intake
Bohaty et al. (2008) [62]	Convenience sampling method	Lincoln, Nebraska, and Ankeny, Iowa.	Day-care center	n = 80, 19 to 29 years, mean age 22.3 ± 3.1 years	8 weeks, ten 45-min slide show presentations on the importance of dietary intake of calcium and vitamin D in preventing osteoporosis. The slide show was followed by an interactive group discussion regarding problems with increasing dietary intake of calcium and vitamin D. After the intervention, subjects received a packet to take home that included an educational handout from the NOF (n.d.) and an outline of the slide show presentation.	Post-test scores on knowledge of osteoporosis, calcium, and vitamin D were significantly higher than pre-test scores 8 weeks after the educational intervention There was no change in dietary intake of calcium, vitamin D, and dairy products from pre- to post-intervention
Goodman, Morrongiello & Meckling (2016) [63]	Randomized controlled trial	Guelph and throughout Ontario.	Community	n = 90, 18 to 25 years	The intervention group watched a video, received online information and tracked intake of vitamin D using a mobile application for 12 weeks.	The increase in vitamin D knowledge from time 1–3 was significantly higher in the intervention than control group (t (88) = 2.26, p = 0.03) The intervention group (M = 3.52, SE = 0.13) had higher overall perceived importance of vitamin D supplementation than the control (M = 3.16, SE = 0.12), F (1, 88) = 4.38, p = 0.04, ηp 2 = 0.05.
Ha et al. (2009) [64]	Class based nutrition intervention	Midwest university	School	n = 80, 18 to 24 years	15 weeks’ class lectures (3 times per weeks for 50 min) focused on healthful dietary choices related to prevention of chronic diseases and were combined with interactive hands on activities and dietary feedback	Class-based nutrition intervention combining traditional lecture and interactive activities was successful in decreasing soft drink consumption Total milk consumption, specifically fat free milk, increased in females and male students changed milk choice favouring skim milk over low fat milk. (1% and 2%)