Am Fam Physician. 2007 Aug 15;76(4):583-584.
Background: Osteoporosis contributes to a significant number of fractures annually in the United States. Primary prevention of bone mineral density (BMD) loss is an important component of preventing osteopenia. A significant amount of bone mass is attained by 18 years of age, with more than one half of it accumulated in adolescence. This makes intervening during youth a vital component of primary prevention of BMD loss. Proper diet and exercise are important components related to BMD, and both have been shown to increase BMD in children and adolescents.
Gender also has a significant effect on risk of osteoporosis; a large proportion of osteoporotic fractures occur in women. Various school-based programs have been used to address osteoporosis prevention. However, programs based in health care settings have not been well studied. A significant number of adolescents visit their physicians on a regular basis and can be influenced by their physician's advice; thus, this is a good time for physicians to help patients establish good habits. DeBar and associates evaluated a health plan–based lifestyle intervention to increase BMD in adolescent girls.
The Study: The study setting was a large health maintenance organization. The population studied was adolescent girls 14 to 16 years of age who each had a body mass index below the national mean. Participants were randomly assigned to an intervention or control group. All participants met in their prospective groups to develop group cohesiveness and to receive orientation to the study. They also were directed to a study Web site; held quarterly team meetings; and received study incentives or points, youth and parent newsletters, and membership to a fitness center. Each participant had an annual visit with researchers to receive feedback and motivation. The intervention group received additional components, including a coaching call four times per year to address adherence issues; bimonthly team meetings to provide information and group support; and weekly self-monitoring postcards with behavioral targets. Dual-energy x-ray absorptiometry measurements of BMD were done at baseline and at one- and two-year follow-up. Behavioral outcomes and bone turnover biomarkers also were assessed.
Results: Of 228 girls, 113 were randomized to the intervention group. The intervention group had significantly higher BMD at the spine and trochanter regions at one year compared with the control group; they maintained this increase during year 2. The intervention group also had biomarkers for bone turnover that were more consistent with an increase in bone building. Compared with the control group, the intervention group had greater consumption of calcium and fruits and vegetables in both years and vitamin D consumption in the first year. There were no differences between the two groups with regard to soda consumption or exercise rates.
Conclusions: The authors conclude that increasing BMD in adolescent girls can be accomplished through a comprehensive health care–based lifestyle intervention. They note that this study is the first nonschool-based intervention that emphasized self-directed behavior changes.
DeBar LL, et al. YOUTH: a health plan–based lifestyle intervention increases bone mineral density in adolescent girls. Arch Pediatr Adolesc Med. December 2006;160:1269–76.
editor's note:The incidence of osteoporosis is anticipated to increase significantly over the next few years. Some of this increase is related to the aging of the population, but another component is low calcium intake. One of the current recommendations for prevention of osteoporosis is to counsel girls 11 years or older to maintain adequate calcium intake.1 The study by DeBar and colleagues demonstrated that this can be accomplished by establishing a health care–based program that targets calcium consumption and other components that can reduce the risk of osteoporosis. Starting with a good base BMD during adolescence is thought to reduce the risk of osteoporosis in later life. To reduce the future impact of current dietary habits, physicians need to develop strategies for discussing calcium intake and providing information on the benefits of this dietary change.—k.e.m.
1. American Academy of Family Physicians. Summary of recommendations for clinical preventive services. Accessed February 22, 2007, at: http://www.aafp.org/online/en/home/clinical/exam/k-o.html.
Copyright © 2007 by the American Academy of Family Physicians.
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