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Am Fam Physician. 2007;76(4):583-584

Background: Osteoporosis contributes to a significant number offractures annually in the United States. Primary prevention of bone mineraldensity (BMD) loss is an important component of preventing osteopenia. Asignificant amount of bone mass is attained by 18 years of age, with more thanone half of it accumulated in adolescence. This makes intervening during youtha vital component of primary prevention of BMD loss. Proper diet and exerciseare important components related to BMD, and both have been shown to increaseBMD in children and adolescents.

Gender also has a significant effect on risk of osteoporosis; a largeproportion of osteoporotic fractures occur in women. Various school-basedprograms have been used to address osteoporosis prevention. However, programsbased in health care settings have not been well studied. A significant numberof adolescents visit their physicians on a regular basis and can be influencedby their physician's advice; thus, this is a good time for physicians to helppatients establish good habits. DeBar and associates evaluated a healthplan–based lifestyle intervention to increase BMD in adolescent girls.

The Study: The study setting was a large health maintenanceorganization. The population studied was adolescent girls 14 to 16 years of agewho each had a body mass index below the national mean. Participants wererandomly assigned to an intervention or control group. All participants met intheir prospective groups to develop group cohesiveness and to receiveorientation to the study. They also were directed to a study Web site; heldquarterly team meetings; and received study incentives or points, youth andparent newsletters, and membership to a fitness center. Each participant had anannual visit with researchers to receive feedback and motivation. Theintervention group received additional components, including a coaching callfour times per year to address adherence issues; bimonthly team meetings toprovide information and group support; and weekly self-monitoring postcardswith behavioral targets. Dual-energy x-ray absorptiometry measurements of BMDwere done at baseline and at one- and two-year follow-up. Behavioral outcomesand bone turnover biomarkers also were assessed.

Results: Of 228 girls, 113 were randomized to the interventiongroup. The intervention group had significantly higher BMD at the spine andtrochanter regions at one year compared with the control group; they maintainedthis increase during year 2. The intervention group also had biomarkers forbone turnover that were more consistent with an increase in bone building.Compared with the control group, the intervention group had greater consumptionof calcium and fruits and vegetables in both years and vitamin D consumption inthe first year. There were no differences between the two groups with regard tosoda consumption or exercise rates.

Conclusions: The authors conclude that increasing BMD inadolescent girls can be accomplished through a comprehensive health care–basedlifestyle intervention. They note that this study is the first nonschool-basedintervention that emphasized self-directed behavior changes.

editor's note:The incidence of osteoporosis is anticipated toincrease significantly over the next few years. Some of this increase isrelated to the aging of the population, but another component is low calciumintake. One of the current recommendations for prevention of osteoporosis is tocounsel girls 11 years or older to maintain adequate calcium intake.1 The study by DeBar andcolleagues demonstrated that this can be accomplished by establishing a healthcare–based program that targets calcium consumption and other components thatcan reduce the risk of osteoporosis. Starting with a good base BMD duringadolescence is thought to reduce the risk of osteoporosis in later life. Toreduce the future impact of current dietary habits, physicians need to developstrategies for discussing calcium intake and providing information on thebenefits of this dietary change.—k.e.m.

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