Table 1.
Characteristics of included studies
| First author, country | Publication year | Type of trial/blinding | Sample size in each groups | Age groups (years) | Primary outcome |
|---|---|---|---|---|---|
| Gonzalo-Encabo,[22] Canada | 2019 | Two-center, two-arm, RCT | High dose aerobic group (n=192) Moderate dose aerobic group (n=187) |
50-74 | BMD and content in postmenopausal women |
| Cleghorn,[25] Australia | 2001 | Open crossover trial | Milk first (n=56) Usual diet first (n=59) |
>50 | Reduces bone loss in women who are within 5 years of the menopause |
| Ciaschini,[24] Canada | 2010 | RCT | Patient education and patient-specific recommendations (n=101) Control group (n=100) |
≥55 | Implementation of appropriate osteoporosis management |
| Karakiriou,[41] Greece | 2012 | RCT | Exercise group (n=10) Vibration group (n=13) Control group (n=9) |
46-62 | BMD and muscle strength program |
| Chien,[42] Taiwan | 2000 | Quasi-experimental | Exercise group (n=22) Control group (n=21) |
48-65 | Enhancing physical fitness and BMD |
| Chan,[23] Hong Kong | 2004 | Randomized, prospective trial | Exercise group (n=67) Sedentary control group (n=65) |
N/A | BMD assessment |
| De Oliveira,[26] Brazil | 2018 | RCT | Vibration group (n=17) Pilates group (n=17) Control group (n=17) |
40-70 | BMD assessment |
| Estok,[27] USA | 2007 | RCT | DXA scan group (n=101) Control group (n=102) |
50-65 | Change general knowledge of osteoporosis and increase the calcium intake and increased weight-bearing exercise |
| Kemmler,[44] Germany | 2005 | Quasi-experimental | Exercise group (n=86) Control group (n=51) |
48-60 | Osteoporosis prevention |
| Feldstein,[28] USA | 2006 | RCT | EMR message (n=101) Usual care (n=101) EMR reminder+patient reminder (n=109) |
50-89 | Increase guideline-recommended osteoporosis care postfracture |
| Francis,[29] Australia | 2009 | A wait list controlled trial | Education group (n=103) Control group (n=95) |
>40 | Changed knowledge and health directed behavior |
| Going,[38] USA | 2003 | RCT | Exercise group (n=142) No exercise or control group (n=124) |
40-65 | Changes in BMD level |
| Ha,[48] China | 2014 | Quasi-experimental | Education group (n=23) control group (n=23) |
≥50 | Knowledge about osteoporosis, dietary calcium intake and the importance of physical activity |
| Kemmler,[43] Germany | 2002 | Quasi-experimental | Exercise group (n=86) Control group (n=51) |
N/A | Physical fitness, and change the BMD, and parameters related to quality of life |
| Kulp,[30] USA | 2004 | RCT | Educational video group (n=98) Control group (n=97) |
3580 | Patient behavior |
| Laslett,[31] Australia | 2011 | Quasi-experimental | OPSMC group (n=75) One session educational course group (n=71) |
≥50 | Osteoporosis knowledge and dietary calcium |
| Kemmler,[32] Germany | 2017 | Quasi-experimental | Exercise group (n=86) Control group (n=51) |
N/A (early postmenopausal women) | Total clinical fracture rate |
| Shu,[33] USA | 2009 | Cluster RCT | Educational group (n=972) Control group (primary care physicians) (n=875) |
≥65 | Improving the management of osteoporosis (initiation of BMD testing and pharmacotherapy for osteoporosis) |
| Oh,[35] Korea | 2014 | RCT | TLM group (n=21) Control group (receiving an educational booklet) (n=20) |
≥45 | Improve bone health (changes in knowledge, self-efficacy, and health behaviors concerning bone health) |
| Rolnick,[34] USA | 2001 | RCT | Education only group (n=301) Education plus BMD group (n=207) Control group (n=187) |
45-65 | BMD testing, initiation of lifestyle changes and pharmaceutical treatment |
| Sedlak,[46] USA | 2005 | Quasi-experimental | Tailored intervention (n=23) Control group (n=101) |
50-65 | Increases in knowledge of osteoporosis, health beliefs, or osteoporosis-prevention behaviors |
| Shakil,[47] USA | 2010 | Quasi-experimental | Educational seminar regarding osteoporosis (n=61) | ≥40 | Awareness of osteoporosis |
| Rafiq,[37] Pakistan | 2018 | Quasi-experimental | Treated by medication and weight bearing exercises (n=137) Medication alone (n=137) |
40-94 | Change in T-score |
| Newstead,[36] USA | 2004 | RCT | Jumping exercise (n=23) Control group (n=26) |
50-65 | Changes in BMD level |
| Ilona,[45] Romania | 2010 | Quasi-experimental | Medication, diet and exercises program (n=23) Control group (only diet and medication) (n=23) |
43-65 | BMD on the lumbar spine |
| Shirazi,[39] Iran | 2007 | RCT | TTM-based exercise education program (n=61) control group (n=55) | 40-65 | Enhancing Physical activity and strength training, muscle mass and bone density |
| Vanaky,[49] Iran | 2015 | RCT | Water exercise group (n=10) Control group (n=10) |
50-70 | BMD of the lumbar spine |
| Barzanjeh,[40] Iran | 2017 | Quasi experimental | Strength training program in water (n=15) Control group (n=15) |
50-65 | Strength training in water on BMD of the lumbar spine and femoral neck in postmenopausal women |
|
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| First author, country | Type of intervention | Duration of intervention in each session | Outcome measurement | Time of outcome measurement | Results |
|
| |||||
| Gonzalo-Encabo,[18] Canada | Aerobic exercise | 30-60 min/sessions of aerobic exercise | BHQ Canadian Diet History Questionnaire |
24 months | At 12 months, mean BMD among women in the high dose group was significantly higher than that of women randomized to the moderate dose group (P=0.02). The mean difference between groups remained statistically significant at 24 months (P=0.04) |
| Cleghorn,[19] Australia | Supplement of calcium-fortified milk versus usual diets | N/A | XR-36 Quickscan DEXA Fasting and 24-h urine samples |
2 years | The rate of bone loss from the spine was 1.76% points less in women with taking the milk supplement compared to usual diet (P=0.006) |
| Ciaschini,[20] Canada | Education | N/A | A brief OPTQoL | 6 and 12 months | More individuals in the intervention group were taking calcium and vitamin compared to the usual care group (P<0.05) |
| Karakiriou,[21] Greece | Vibration and exercise training | 3 days a week per session (15 min) | DEXA Serum osteocalcin by radioimmunoassay HPLC |
6 months | The BMD of L2_L4 increased in the exercise group (P<0.05), remained steady in the vibration group, and decreased in the control group (P<0.05) |
| Chien,[22] Taiwan | Aerobic exercise program | 50 min | Interviewer-administered Physical activity questionnaire, 3 days food frequency questionnaire |
24 weeks | Aerobics combined with high-impact exercise at a moderate intensity was effective in offsetting the decline in BMD in intervention group (P<0.05) |
| Chan,[23] Hong Kong | Programmed TCC exercise |
45 min a day for 5 days a week | DEXA Multislice pQCT |
12 months | General bone loss in both TCC and sedentary control subjects at all measured skeletal sites, but with a reportedly slower rate in the TCC group. A significant 2.6-3.6-foldretardation of bone loss (P=0.01) was found in both trabecularand cortical compartments of the distal tibia in the TCC group compared with the control group |
| De Oliveira,[24] Brazil | Whole-body vibration versus pilates exercise | 3 times a week for totaling 78 sessions | Dual-energy x-ray absorptiometry | 6 months | Significant mean differences between vibration (P=0.018) and pilates (P=0.012) versus control, for the BMD of the lumbar spine and trochanter in postmenopausal women |
| Estok,[25] USA | DEXA scan | 15 min for DEXA | Osteoporosis knowledge test Osteoporosis Health Belief Scale The Osteoporosis Self-Efficacy Scale |
6 and 12 months | The experimental manipulation had a direct positive effect (P<0.05) on calcium intake at6 months, and indirectly at 12 months. Providing DXA results did not relate to change in exercise |
| Kemmler,[26] Germany | Group exercise session | Four sessions per week (65-70 min each session) | DXA at the lumbar spine (L1-4) A detailed baseline questionnaire Individual 5-d dietary records |
38 months | After 38 months, significant differences between intervention and control groups were observed for the BMD at the lumbar spine, the femoral neck, body composition and menopausal symptoms (P<0.001) |
| Feldstein,[27] USA | EMR message or electronic reminder to the provider plus an educational letter mailed to the patient | 2-3 min per patient | EMR message or electronic reminder | 3 and 6 months | The effect of provider advice combined with patient education was not significantly different from provider advice alone (P=0.88) |
| Francis,[28] Australia | Education and self-management course | 2-2.5 h session | OKAT HeiQ OSES |
6 weeks | At 6-week follow-up, the intervention group showed a significant increase in osteoporosis knowledge (P<0.001) and a larger increase in health-directed behavior (P<0.05) compared with the control group |
| Going,[29] USA | Exercise sessions included stretching, balance and aerobic weight-bearing activity, weightlifting, an additional weight-bearing circuit of moderate impact activities | 3 days per week for approximately 10 min | DEXA The form of calcium citrate |
8 and 12 months | Trochanteric BMD was significantly increased approximately 1.0% in women who exercised and used calcium without HRT compared to a negligible change in women who used HRT and did not exercise |
| Ha,[30] China | Educational self-efficacy | 6 weekly 1-h sessions | The Chinese FFQ The Chinese Version of the IPAQLC |
3-months | Participants in the educational group had significant improvement in osteoporosis (P<0.001), self-efficacy (P=0.003), dietary calcium intake (P=0.002), level of physical activity (P=0.011) compared to the control group at the 3-month follow-up |
| Kemmler,[31] Germany | Exercise training | Joint exercise session 65-70 min Warm-up/endurance sequence: 15 min Jumping sequence: 1 min |
Schnell-trainer-dynamometer A Schnell M-3 isometric tester Exercise-specific tests A stepwise treadmill test up to voluntary maximum, -flexibility tests DXA |
14 months | There were significant differences between exercise and control groups regarding changes of bone density (P<0.001), maximum isometric strength and quality of life parameters such as lower back pain |
| Kulp,[32] USA | Education | Intervention group viewed an educational video for 10 min/once before their physician `encounter | Researcher made questionnaire for preventing bone loss (taking calcium and Vitamin D supplements, eating calcium-rich foods, and performing weight-bearing exercise) | 3 months | Women in the intervention group in comparison with control group started taking calcium supplements (26.5% versus 4.9%; P<0.001), started taking Vitamin D supplements (20.6% versus 6.6%; P=0.02), started a program of weight-bearing exercise (13.3% versus 1.7%; P=0.03), and started hormone therapy (8% versus 1%; P=0.04) |
| Laslett,[33] Australia | Education/nutritional management | 2.5 h, once a week for 4 consecutive weeks | OKAT Dietary calcium intake frequency questionnaire OSES Community healthy activities model program for seniors |
3 months | Osteoporosis knowledge and calcium from food increased after 3 months in both groups (P<0.01). Use of osteoporosis medications increased between baseline and 3 months in the OPSMC group while decreasing in the one-session group (P=0.039). There were no differences between the groups or over time in physical activity, calcium or exercise self-efficacy |
| Kemmler,[34] Germany | Physical activity | Two group classes of 60 to 65 min and two home training sessions of 20 to 25 min for 49 to 50 weeks a year | Pain frequency and intensity of the lower back 10-year hard CHD risk (myocardial infarction, coronary death) Frequency of fracture assessment plus structured interviews |
16 years | The ratio for clinical overall fractures was significantly lower in the exercise group 0.47 (95% CI: 0.24-0.92; P=0.03) |
| Shu,[35] USA | Education | 3 months | MPR (the ratio of available medication to the total number of days studied) | 10 months | There were no significant differences between the intervention group with 74% median MPRs (interquartile range [IQR], 19%-93%) and control group with 73% (IQR, 0%-93%) (P=0.18) |
| Oh,[36] Korea | Education/exercise/Vitamin D supplementation | 24-session, 2 times a week for 3 months) | DXA Bone biomarkers in serum and urine 27-item true-false test Osteoporosis self-efficacy scale Food frequency questionnaire The Korean Society of bone metabolism Anthropometrics, blood pressure, and pulse rate |
12 weeks | The intervention group compared with the control group showed significant increases in knowledge (P=0.019) and self-efficacy (P<0.01) and improvement in diet and regular exercise (P=0.005) after 12 weeks |
| Rolnick,[37] USA | Education | A 2 h educational session | DEXA Questionnaire of self-reported changes in health behaviors SCORE |
6 months | There were no significant 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 |
| Sedlak,[38] USA | Education | N/A | OPBS OKT OHBS OSES DXA T-score |
6 months | There was no difference in knowledge between groups. Daily calcium intake increased in both groups, but, there was no significant difference between the groups in daily calcium intake. Weight-bearing exercise behaviors decreased from 96.04 min to 59.2 min in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 min of exercise |
| Shakil,[39] USA | Education | N/A | OKAT | 2 weeks | There was a significant difference (paired t60=−9.5, P<0.01) between the before and after the intervention |
| Rafiq,[40] Pakistan | Education/physical activity | 3 months (3 session per week), 5-10 min of warm-up exercise, 20 min of progressive weight bearing exercise, 15 min of resistance exercise with large muscle group, 5 min of stretching and balance | DEXA | 3 months | The DEXA scan median values after treatment were changed to 3.00 (0) for exercises and medication group and 2.00 (1) for medication group |
| Newstead,[41] USA | Physical activity | 2 days per week at 25-200 jumps per session | DXA Urine NTX Serum bone specific ALK PHOS |
12 months | There was not a significant difference between two groups in BMD score (P=0.51) and biomarkers of bone turnover (P=0.221) |
| Ilona,[42] Romania | Physical activity | 1 h exercise program twice a week for 12 months | T-score on the lumbar spine (the lumbar spine (L1-L4) DEXA |
12 months | The exercise group demonstrated a significant gain compared with the control group in T-score (30.3% versus 21.83%;) and spine BMD (12.56% versus 6.5%) |
| Shirazi,[43] Iran | Physical activity | 12 weeks (30-45 min three - time a week) | IPAQ 1RM SEBTs |
12 weeks after intervention | Significant improvements in physical activity (P<0.005), muscle strength (P<0.0001), dynamic balance (P<0.0001) and static balance (P<0.0001) were noted in the training group but not in control group |
| Vanaky,[44] Iran | Physical activity | 12 weeks 60 min that increased gradually to 90 min during 12 weeks | DXA | 12 weeks | There was a significant differences between pretest and posttest of bone density in experimental group (P=0.048) while this difference was not significant for the control group (P=0.872) |
| Barzanjeh,[45] Iran | Physical activity | 12-month strength training program in water, 3 times a week (Monday, Wednesday, and Friday), for 50 min | Bone densitometry of l2 and l3 vertebrae and femoral neck | 12 months | The strength training in the water had a significant effect on bone mineral density of L2-L3 vertebra (P=0/000) and bone mineral density of the femur (P=0/000) in postmenopausal women |
RCT=Randomized controlled trials, EMR=Electronic medical record, N/A=Not available, DXA=Dual X-ray absorptiometry, TLM=Therapeutic lifestyle modification, BMD=Bone mineral density, TCC=Tai Chi Chun, BHQ=Baseline Health Questionnaire, DEXA=Dual-energy X-ray densitometer, OPTQoL=Osteoporosis-targeted Quality of Life, HPLC=High-performance liquid chromatography, pQCT=Peripheral quantitative computed tomography, OKAT=Osteoporosis knowledge assessment test, HeiQ=Health Education Impact Questionnaire, OSES=The Osteoporosis Self-Efficacy Scale, FFQ=Food Frequency Questionnaire, IPAQLC=International physical activity questionnaire, long form, MPR=Medication possession ratio, SCORE=Simple calculated osteoporosis risk estimation, OPBS=Osteoporosis-preventing behaviors survey, OKT=Osteoporosis knowledge test, OHBS=The Osteoporosis Health Belief Scale, DEXA=Dual energy X-ray absorptiometry, NTX=N-telopeptide, ALK PHOS=Alkaline phosphatase, IPAQ=International Physical Activity Questionnaire, 1RM=One-repetition maximum, SEBTs=Star-excursion balance tests, HRT=Hormone replacement therapy, TTM=Trans theoretical model