Journal of Education and Health Promotion

Prevention of osteoporosis in menopausal women: A systematic review of nonpharmacological clinical trials

Authors

. Azam Mohammadi
. Zahra Behboodi Moghadam
. Fatemeh Ghelichkhani
. Farzane Alidost
. Somayyeh Naghizadeh
. Zeinab Haghparast
. Marzieh Azizi
Abstract
Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial
consequences, so understanding the effective strategies that can be used in the prevention of
osteoporosis is especially important. The aim of this study was to integrative review the published
interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis
among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web
of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian
databases, such as Scientific Information Database and Magiran, were searched. The latest search
was performed between “November 2020 and December 2020” separately by two researchers and
then double‑checked by them. The quality of the included studies was assessed using the Jadad
score calculation tool. Twenty eight randomized controlled trials and quasi‑experimental studies were
included in this current study. The quality assessment indicated that 19 studies had acceptable (good)
methodological quality and also 9 studies had weak methodological quality. The main results of this
study were classified in three main categories such as exercise or physical activity training (n = 15),
educational sessions (n = 11), and other interventions (n = 2). The results of most included studies
showed that nonpharmacological strategies such as physical activity and educational interventions
are considered as the appropriate actions to prevention of osteoporosis among menopausal women
so implementing these strategies can be a good alternative for women with contraindication of
hormone therapy or therapeutic treatment.

Keywords

Education
exercise
menopause
osteoporosis
program
  1. Sherman S. Defining the menopausal transition. Am J Med
    2005;118 Suppl 12B:3‑7.
    2. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al.
    Executive summary of the Stages of Reproductive Aging
    Workshop+10: Addressing the unfinished agenda of staging
    reproductive aging. J Clin Endocrinol Metab 2012;97:1159‑68.
    3. Soltani A, Sedaghat M, Adibi H, Hamidi Z, Shenazandi H,
    Khalilifar A, et al. Risk factor analysis of osteoporosis in women
    referred to bone densitometry unit of Endocrinology and
    Metabolism Research Center of Tehran University of Medical
    Sciences. Iran South Med J 2002;5:82-91.
    4. Tsao LI. Relieving discomforts: The help‑seeking experiences
    of Chinese perimenopausal women in Taiwan. J Adv Nurs
    2002;39:580‑8.
    5. Smith CA. A systematic review of healthcare professional‑led
    education for patients with osteoporosis or those at high risk for
    the disease. Orthop Nurs 2010;29:119‑32.
    6. El‑Hajj Fuleihan G, Adib G, Nauroy L. The middle east & Africa
    regional audit, epidemiology, costs & burden of osteoporosis in
    2011. Switzerland: An International Osteoporosis Foundation
    (IOF) Publication; 2011.
    7. Ardeshir Larijani MB, Aaf S, Pazhouhi M, Bastan Hagh MH,
    Mirfeizi SZ, Dashti R, et al. Bone mineral density variations in
    20‑69 yr. population of Tehran/Iran. Iran South Med J 2002;5:41‑9.
    8. Prada G, Fita I, Nacu R, Ignat I, Petrescu R, Jugravu O, et al. Risk
    factors for complications of osteoporosis in older people. Eur
    Geriatr Med 2013;4:S25.
    9. Gold DT, Shipp KM, Lyles KW. Managing patients with
    complications of osteoporosis. Endocrinol Metab Clin North Am
    1998;27:485‑96.
    10. Magee JA, Stuberg WA, Schmutte GT. Bone health knowledge,
    self‑efficacy, and behaviors in adolescent females. Pediatr Phys
    Ther 2008;20:160‑6.
    11. Stránský M, Ryšavá L. Nutrition as prevention and treatment of
    osteoporosis. Physiol Res 2009;58 Suppl 1:S7‑11.
    12. Larijani B, Tehrani MM, Hamidi Z, Soltani A, Pajouhi M.
    Osteoporosis, prevention, diagnosis and treatment. J Reprod
    Infertil 2005;6:5‑25.
    13. Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P,
    et al. Evidence suggesting that a chronic disease self‑management
    program can improve health status while reducing hospitalization:
    A randomized trial. Med Care 1999;37:5‑14.
    14. Wagner EH. The role of patient care teams in chronic disease
    management. BMJ 2000;320:569‑72.
  2. 15. Mithal A, Dhingra V, Lau E. The Asian audit: Epidemiology,
    costs and burden of osteoporosis in Asia. Beijing China: An
    International Osteoporosis Foundation (IOF) Publication; 2009.
    16. Chan MF, Ko CY. Osteoporosis prevention education programme
    for women. J Adv Nurs 2006;54:159‑70.
    17. de Souza MP. Osteoporosis diagnosis and treatment. Rev Bras
    Ortop 2010;45:220‑9.
    18. Halpern S, Douglas M. Jadad scale for reporting randomized
    controlled trials. Evidence-based Obstetric Anesthesia. Oxford,
    UK: Blackwell Publishing Ltd, 2005.
    19. Berger VW, Alperson SY. A general framework for the evaluation
    of clinical trial quality. Rev Recent Clin Trials 2009;4:79‑88.
    20. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ,
    Gavaghan DJ, et al. Assessing the quality of reports of randomized
    clinical trials: Is blinding necessary? Control Clin Trials
    1996;17:1‑12.
    21. Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, MorideY.
    Interrater reliability of the modified Jadad quality scale for
    systematic reviews of Alzheimer’s disease drug trials. Dement
    Geriatr Cogn Disord 2001;12:232‑6.
    22. Gonzalo‑Encabo P, McNeil J, Boyne DJ, Courneya KS,
    Friedenreich CM. Dose‑response effects of exercise on bone
    mineral density and content in post‑menopausal women. Scand
    J Med Sci Sports 2019;29:1121‑9.
    23. Chan K, Qin L, Lau M, Woo J, Au S, Choy W, et al. A randomized,
    prospective study of the effects of Tai Chi Chun exercise on bone
    mineral density in postmenopausal women. Arch Phys Med
    Rehabil 2004;85:717‑22.
    24. Ciaschini PM, Straus SE, Dolovich LR, Goeree RA, Leung KM,
    Woods CR, et al. Community based intervention to optimize
    osteoporosis management: Randomized controlled trial. BMC
    Geriatr 2010;10:60.
    25. Cleghorn DB, O’Loughlin PD, Schroeder BJ, Nordin BE. An open,
    crossover trial of calcium‑fortified milk in prevention of early
    postmenopausal bone loss. Med J Aust 2001;175:242‑5.
    26. de Oliveira LC, de Oliveira RG, de Almeida Pires‑Oliveira DA.
    Effects of whole‑body vibration versus Pilates exercise on bone
    mineral density in postmenopausal women: A randomized and
    controlled clinical trial. J Geriatr Phys Ther 2019;42:E23‑31.
    27. Estok PJ, Sedlak CA, Doheny MO, Hall R. Structural model for
    osteoporosis preventing behavior in postmenopausal women.
    Nurs Res 2007;56:148‑58.
    28. Feldstein A, Elmer PJ, Smith DH, Herson M, Orwoll E, Chen C,
    et al. Electronic medical record reminder improves osteoporosis
    management after a fracture: A randomized, controlled trial. J Am
    Geriatr Soc 2006;54:450‑7.
    29. Francis KL, Matthews BL, Van Mechelen W, Bennell KL,
    Osborne RH. Effectiveness of a community‑based osteoporosis
    education and self‑management course: A wait list controlled
    trial. Osteoporos Int 2009;20:1563‑70.
    30. Kulp JL, Rane S, Bachmann G. Impact of preventive osteoporosis
    education on patient behavior: Immediate and 3‑month follow‑up.
    Menopause 2004;11:116‑9.
    31. Laslett LL, Lynch J, Sullivan TR, McNeil JD. Osteoporosis
    education improves osteoporosis knowledge and dietary calcium:
    Comparison of a 4 week and a one‑session education course. Int
    J Rheum Dis 2011;14:239‑47.
    32. Kemmler W, Kohl M, von Stengel S. Long‑term effects of exercise
    in postmenopausal women: 16‑year results of the Erlangen
    Fitness and Osteoporosis Prevention Study (EFOPS). Menopause
    2017;24:45‑51.
    33. Shu AD, Stedman MR, Polinski JM, Jan SA, Patel M, Truppo C,
    et al. Adherence to osteoporosis medications after patient and
    physician brief education: Post hoc analysis of a randomized
    controlled trial. Am J Manag Care 2009;15:417‑24.
    34. Rolnick SJ, Kopher R, Jackson J, Fischer LR, Compo R. What is
    the impact of osteoporosis education and bone mineral density
    testing for postmenopausal women in a managed care setting?
    Menopause 2001;8:141‑8.
    35. Oh EG, Yoo JY, Lee JE, Hyun SS, Ko IS, Chu SH. 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. Res Nurs Health
    2014;37:292‑301.
    36. Newstead A, Smith KI, BruderJ, Keller C. The effect of a jumping
    exercise intervention on bone mineral density in postmenopausal
    women. J Geriatr Phys Ther 2004;27:47.
    37. Rafiq S, Zia S, IjazMJ, Shahid HA, AdeelM. Role of weight‑bearing
    exercises in the treatment of post‑menopausal osteoporosis. J Coll
    Physicians Surg Pak 2018;28:122‑5.
    38. Going S, Lohman T, Houtkooper L, Metcalfe L, Flint-Wagner H, Blew
    R, et al. Effects of exercise on bone mineral density in calciumreplete postmenopausal women with and without hormone
    replacement therapy. Osteoporos Int 2003;14:637-43.
    39. Karimzadeh Shirazi K, Niknami SH, Heydarnia A. Effects of a
    TTM‑based osteoporosis preventive physical activity education,
    on increasing muscle. Hakim Res J 2007;10:34‑42.
    40. Barzanjeh SP, Nouie F, Mirzaei S. Effect of 12 months of strength
    training in water on bone mineral density of the lumbar spine
    and femoral neck in postmenopausal women with osteoporosis.
    Sci J Kurdistan Univ Med Sci 2017;21:27-35.
    41. KarakiriouSK, DoudaHT, Smilios IG, VolaklisKA, Tokmakidis SP.
    Effects of vibration and exercise training on bone mineral density
    and muscle strength in post‑menopausal women. Eur J Sport Sci
    2012;12:81‑8.
    42. Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS. Efficacy of a 24‑week
    aerobic exercise program for osteopenic postmenopausal women.
    Calcif Tissue Int 2000;67:443‑8.
    43. Kemmler W, Engelke K, Lauber D, Weineck J, Hensen J,
    Kalender WA. Exercise effects on fitness and bone mineral density
    in early postmenopausal women: 1‑year EFOPS results. Med Sci
    Sports Exerc 2002;34:2115‑23.
    44. Kemmler W, von Stengel S, Weineck J, Lauber D, Kalender W,
    Engelke K. Exercise effects on menopausal risk factors of early
    postmenopausal women: 3‑yr Erlangen fitness osteoporosis
    prevention study results. Med Sci Sports Exerc 2005;37:194‑203.
    45. Ilona I, Taina A, Mirela S, Eugenia R, Mihaela Z. The role of
    high‑impacts exercises in improve bone mineral density in
    postmenopausal women with osteopenia or osteoporosis. Citius
    Altius Fortius 2010;27:110.
    46. Sedlak CA, Doheny MO, Estok PJ, Zeller RA. Tailored
    interventions to enhance osteoporosis prevention in women.
    Orthop Nurs 2005;24:270‑6.
    47. Shakil A, Gimpel NE, Rizvi H, Siddiqui Z, Ohagi E, Billmeier TM,
    et al. Awareness and prevention of osteoporosis among South
    Asian women. J Community Health 2010;35:392‑7.
    48. Ha M, Hu J, Petrini MA, McCoy TP. The effects of an educational
    self‑efficacy intervention on osteoporosis prevention and diabetes
    self‑management among adults with type 2 diabetes mellitus. Biol
    Res Nurs 2014;16:357‑67.
    49. Vanaky B, Sadeghi H, Piri M, Ramezani N. The effect of weight
    bearing water aerobic exercise on the bone density of the lumbar
    spine of 50‑70 years old overweight women. Sci J Rehabil Med
    2015;4:46‑52.
    50. Kolbe‑Alexander TL, Charlton KE, Lambert EV. Lifetime physical
    activity and determinants of estimated bone mineral density using
    calcaneal ultrasound in older South African adults. J Nutr Health
    Aging 2004;8:521‑30.
    51. Nilsson M, Ohlsson C, Eriksson AL, Frändin K, Karlsson M,
    Ljunggren O, et al. Competitive physical activity early in life is
    associated with bone mineral density in elderly Swedish men.
    Osteoporos Int 2008;19:1557‑66.
    52. Karinkanta S, Heinonen A, Sievänen H, Uusi‑Rasi K, Pasanen M,
    Ojala K, et al. A multi‑component exercise regimen to prevent functional decline and bone fragility in home‑dwelling
    elderly women: Randomized, controlled trial. Osteoporos Int
    2007;18:453‑62.
    53. Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi‑Rasi K,
    Kannus P. Targeted exercise against osteoporosis: A systematic
    review and meta‑analysis for optimising bone strength
    throughout life. BMC Med 2010;8:47.
    54. Gusi N, Raimundo A, Leal A. Low‑frequency vibratory
    exercise reduces the risk of bone fracture more than walking:
    A randomized controlled trial. BMC Musculoskelet Disord
    2006;7:92.
    55. Yoo JE, Park HS. Prevalence and associated risk factors for
    osteoporosis in Korean men. Arch Osteoporos 2018;13:88.
    56. Askari M, Lotfi MH, Owlia MB, Fallahzadeh H, Mohammadi M.
    Survey of osteoporosis risk factors (Review Article). J Sabzevar
    Univ Med Sci 2018;25:854‑63.
    57. Zehnacker CH, Bemis‑Dougherty A. Effect of weighted exercises
    on bone mineral density in post menopausal women. A systematic
    review. J Geriatr Phys Ther 2007;30:79‑88.
    58. Alexandre C, Vico L. Pathophysiology of bone loss in disuse
    osteoporosis. Joint Bone Spine 2011;78:572‑6.
    59. Jensen AL, Lomborg K, Wind G, Langdahl BL. Effectiveness and
    characteristics of multifaceted osteoporosis group education – A
    systematic review. Osteoporos Int 2014;25:1209‑24.
Journal of Education and Health Promotion
Volume 12, Issue 8
September 2022
Pages 1-18

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