title: Effect of community-based nutrition education intervention on calcium intake and bone mass in postmenopausal Vietnamese women. New findings from non-linear longitudinal modelling of menopausal hormone changes. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260] Calcium plus vitamin D supplementation and the risk of fractures. Nutrition education in postmenopausal women: changes in dietary and cardiovascular indices. Recommendations from a multi-study evaluation of proposed criteria for Staging Reproductive Aging Impact of preventive osteoporosis education on patient behavior: immediate and 3-month follow-up Modeling women's health during the menopausal transition: a longitudinal analysis Tailored Interventions to Enhance Osteoporosis Prevention in Women Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women. Effects of Educational Materials concerning Osteoporosis on Women's Knowledge, Beliefs, and Behavior The Effects of an Educational Intervention on Calcium Intake and Bone Mineral Content in Young Women with Low Calcium Intake
abstract: OBJECTIVE To examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women . DESIGN A controlled trial was conducted in two groups as intervention and control . The intervention group was given nutrition education during 18 months to improve calcium intake , while the control subjects had the usual diet .  Calcium intake and bone mass were evaluated every 6 months . Bone mass was assessed by speed of sound ( SOS ) at calcaneus , referred to as quantitative ultrasound measurement . Anthropometric indices and serum parathyroid hormone ( PTH ) were determined at baseline and at the end of intervention . SETTING Two rural communes of Hai Duong province located in the Red River Delta in Vietnam . SUBJECTS A total of 140 women aged 55 - 65 years , who were more than 5 years postmenopausal and with low calcium intake ( < 400 mg/d ) , were recruited . After 18 months of intervention , 108 women completed the study . RESULTS Calcium intake in the intervention group had increased significantly ( P < 0.01 ) while it had no significant changes in controls . SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0.5 % in the controls ( P < 0.01 ) . The intervention led to a decrease in serum PTH by 12 % ( P < 0.01 ) . In the controls , there was an increase in serum PTH by 32 % ( P < 0.001 ) . CONCLUSION Nutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects Changes in  FSH and estradiol ( E2 ) across the menopausal transition are clearly not linear . The present study utilizes data from 204 women who completed the 13-year prospect i ve Melbourne Women 's Midlife Health Project .  E2 , FSH , symptoms , self-rated health , mood , sexual function and coronary heart disease ( CHD ) risk were measured longitudinally . We presumed an s-shaped curve for each hormone and estimated five parameters for each hormone curve for each woman : baseline , final value , range , slope at inflexion point and age at inflexion point . These parameters were found to adequately estimate the curve for each hormone . The median age of transition observed for E2 occurs > 1 year later than the median age of transition observed for FSH . FSH parameters did not affect any of the health outcomes analysed . Hot flushes , night sweats , sleeping problems , vaginal dryness and to a lesser extent self-rated health were highly significantly associated with E2 range and slope . Sexual response and CHD risk were highly significantly associated with final E2 level ( post-menopausally ) . These findings have clinical relevance in identifying which symptoms will be triggered by steep transitions of E2 such as sudden withdrawal and which health parameters may require a maintenance level of E2 Background Limited information is available on ways to influence osteoporosis risk in premenopausal women . This study tested four hypotheses regarding the effects of individualized bone density ( BMD ) feedback and different educational interventions on osteoporosis preventive behavior and BMD in pre-menopausal women , namely : that women are more likely to change calcium intake and physical activity if their BMD is low ; that group education will be more efficacious at changing behavior than an information leaflet ; that BMD feedback and group education have independent effects on behavior and BMD ; and , that women who improve their physical activity or calcium intake will have a change in bone mass over 2 years that is better than those who do not alter their behavior . Methods We performed a 2-year r and omized controlled trial of BMD feedback according to T-score and either an osteoporosis information leaflet or small group education in a population -based r and om sample of 470 healthy women aged 25–44 years ( response rate 64 % ) . Main outcome measures were dietary calcium intake , calcium supplement use , smoking behavior , physical activity , endurance fitness , lower limb strength and BMD . We used paired t-tests , one-way ANOVA and linear regression techniques for data analysis . Results Women who had feedback of low BMD had a greater increase in femoral neck BMD than those with normal BMD ( 1.6 % p.a . vs. 0.7 % p.a . , p = 0.0001 ) , but there was no difference in lumbar spine BMD change between these groups ( 0.1 % p.a . vs. 0.08 % p.a . , p = 0.9 ) . Both educational interventions had similar increases in femoral neck BMD ( Leaflet = + 1.0 % p.a . , Osteoporosis self-management course = + 1.3 % p.a . , p = 0.4 ) . Femoral neck BMD change was only significantly associated with starting calcium supplements ( 1.3 % p.a , 95%CI + 0.49 , + 2.17 ) and persistent self-reported change in physical activity levels ( 0.7 % p.a . , 95%CI + 0.22 , + 1.22 ) . Conclusion Individualized BMD feedback combined with a minimal educational intervention is effective at increasing hip but not spine bone density in premenopausal women . The changes in behavior through which this was mediated are potentially important in the prevention of other diseases , thus measuring BMD at a young age may have substantial public health benefits , particularly if these changes are sustained BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal . METHODS We recruited 36,282 postmenopausal women , 50 to 79 years of age , who were already enrolled in a Women 's Health Initiative ( WHI ) clinical trial . We r and omly assigned participants to receive 1000 mg of elemental [ corrected ] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo .  Fractures were ascertained for an average follow-up period of 7.0 years . Bone density was measured at three WHI centers . RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group ( P<0.01 ) . Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture ( 95 percent confidence interval , 0.72 to 1.08 ) , 0.90 for clinical spine fracture ( 0.74 to 1.10 ) , and 0.96 for total fractures ( 0.91 to 1.02 ) . The risk of renal calculi increased with calcium plus vitamin D ( hazard ratio , 1.17 ; 95 percent confidence interval , 1.02 to 1.34 ) . Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 ( 95 percent confidence interval , 0.52 to 0.97 ) . Effects did not vary significantly according to prer and omization serum vitamin D levels . CONCLUSIONS Among healthy postmenopausal women , calcium with vitamin D supplementation result ed in a small but significant improvement in hip bone density , did not significantly reduce hip fracture , and increased the risk of kidney stones . ( Clinical Trials.gov number , NCT00000611 . ) OBJECTIVE The aim of the current study was to examine whether a diet rich in dairy products followed by a nutrition education program for the prevention of osteoporosis could have any adverse effect on certain cardiovascular disease ( CVD ) risk factors over a 5-month intervention period . METHODS A total sample of 82 women ( 55 - 65 years old ) was r and omized to a dietary intervention group ( IG : n=42 ) , attending biweekly nutrition education program and provided with low-fat , fortified dairy products and to a control group ( CG : n=40 ) . Changes in dietary , biochemical and clinical indices related to CVD were determined at the end of the 5-month intervention period . RESULTS The IG was found to have a higher decrease in the percentage of energy intake derived from total fat and a higher increase in the intake of calcium , phosphorus , magnesium and potassium compared to the CG ( p<0.05 ) . Furthermore , the IG subjects were found to have a lower increase in BMI ( 0.7+/-0.1 versus 1.4+/-0.2 Kg/m(2 ) , p=0.011 ) and systolic blood pressure ( SBP ) ( 2.5+/-2.9 versus 7.8+/-2.2 mmHg , p=0.040 ) and a higher decrease in serum total cholesterol ( -5.2+/-3.3 versus 6.9+/-5.1 mg/dl , p=0.042 ) and LDL-cholesterol levels ( -20.0+/-2.6 versus -12.4+/-4.2 mg/dl , p=0.034 ) compared to the CG . CONCLUSIONS The findings of the current study indicate that a dietary intervention aim ing to minimize the risk for osteoporosis did not have any adverse effects on CVD risk factors . On the contrary , it has induced favourable changes in BMI , serum lipids and SBP In 2001 , the Stages of Reproductive Aging Workshop ( STRAW ) proposed bleeding and endocrine criteria for defining the early and late menopausal transition stages . Based on expert consensus , STRAW recommended a shorter interval of amenorrhea than the commonly used 90-day amenorrhea criteria for late transition and a > 7-day change in cycle length for early transition . The ReSTAGE collaboration  used prospect i ve menstrual calendar data from four cohorts ( TREMIN , Melbourne Women 's Midlife Health Project , Seattle Midlife Women 's Health Study , and Study of Women 's Health Across the Nation ) to quantitatively evaluate STRAW 's recommendations . This empirical assessment supported the STRAW recommendations that ( 1 ) ≥60 days of amenorrhea be used to define the late menopausal transition and ( 2 ) that early transition is consistent with a persistent 7 or more day difference in length of consecutive cycles . Serum follicle stimulating hormone ( FSH ) values ≥40 IU/l was an independent marker of the transition and , when occurring together with a bleeding marker , increased prediction of final menstrual period . Such a FSH criterion could be incorporated into the STRAW paradigm to facilitate prediction of proximity of the final menstrual period Objective To evaluate the effectiveness of an educational video on osteoporosis at increasing knowledge and preventive health behaviors . Design A total of 195 women between 35 and 80 years of age without documented osteopenia or osteoporosis , who presented for a gynecological examination in an outpatient setting , were enrolled . Of this number , 98 women were r and omly assigned to the intervention group that viewed the video before their office visit , and 97 women were assigned to a control group and saw their physician in a routine manner . After their visit , all participants answered a question naire that assessed their knowledge of osteoporosis and baseline health-related behaviors . Three months later , a follow-up question naire was mailed to participants , eliciting whether preventive behavior had commenced . Frequencies were compared using the Fisher exact test ( 2-tailed ) . Continuous variables were analyzed using the Student 's t test . Results The two groups had no statistically significant differences in demographics . The intervention group scored a mean of 92 % compared with a mean of 80 % in the control group on the initial osteoporosis assessment question naire ( P < 0.001 ) . The 3-month follow-up question naire demonstrated that significantly more women in the intervention group started taking calcium supplements  ( 26.5 % v 4.9 % ; P < 0.001 ) , started taking vitamin D supplements  ( 20.6 % v 6.6 % ; P = 0.02 ) , started a  program of weight-bearing exercise  ( 13.3 % v 1.7 % ; P = 0.03 ) , and started  hormone therapy ( 8 % v 1 % ; P = 0.04 ) . Conclusion The use of an educational video on osteoporosis seems to improve patient knowledge and may positively impact health-related behaviors Objective : There has been controversy about the relative effects on various health outcomes of hormonal , psychosocial , and lifestyle changes during the menopausal transition . In previous studies the risk factors for one particular health endpoint have been analyzed separately . Separate analyses do not provide an overall view of the relationships between all the variables or the relative importance of different factors . Thus , the objective of this study was to provide an overall analysis of the influence of hormonal changes during the menopausal transition on a range of health outcomes while simultaneously considering all the available predictors and all the endpoints and to test the hypothesis that prior health status predicts current health status . Design : This was a 9-year prospect i ve observational study of 438 Australian-born women , who at baseline were aged 45 to 55 years and had menstruated in the prior 3 months .  Interviews were conducted and fasting blood and physical measurements were performed annually . Results : Main outcome measures were hormone levels , sociodemographic variables , attitudes and lifestyle variables , self-rated health and well-being , bothersome symptoms , coronary heart disease risk , bone mineral density , and sexuality .  Data from 336 women , 77 % of the original sample , were analyzed . Statistical modeling using structural equations showed that for all health endpoints , the prior level of that variable was the most important predictor . Declining levels of estradiol during the menopausal transition affected certain health outcomes : bone mineral density , coronary heart disease risk , vasomotor symptoms , vaginal dryness , and sexual response . Well-being is negatively affected by symptoms , hassles , and stress . Exercise  has beneficial effects on hot flushes , well-being , body mass index , and coronary heart disease risk . Relationship factors and mood affect sexual response . Conclusions : This observational study provides a conceptual data -based framework for underst and ing changes in women 's health during the natural menopausal transition PURPOSE The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis , health beliefs , or osteoporosis-prevention behaviors in postmenopausal women 50–65 years of age , 6 months after the intervention . METHOD The design for this pilot study was a two group quasi-experimental design . The treatment group received a tailored intervention ; the control group did not . Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry . The tailored intervention was design ed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis question naire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake , exercise , smoking , and alcohol use . A written mailed copy of the intervention followed the telephone interview . Six months after the intervention , the women were mailed another osteoporosis question naire to determine if the tailored intervention made a difference in the outcome variables . SAMPLE A total 124 women between the ages of 50 and 65 ( 101 control , 23 treatment ) comprised the sample . RESULTS There was no difference in knowledge between groups . On the average , there were significantly more perceived barriers to calcium in the tailored group ( mean = 13.48 ) than in the nontailored group ( mean = 11.55 ) ( t = 2.147 ; df = 122 ; p = .034 ) . There were significantly more perceived barriers to exercise in the tailored group ( mean = 14.39 ) than in the nontailored group ( mean = 12.21 ) ( t = .144 ; df = 122 ; p = .034 ) . Daily calcium intake increased in both the tailored and the nontailored groups . The tailored intervention increased women 's daily calcium intake from 614.28 to 1039.10 mg ( t = −2.896 ; df = 22 ; p = .008 ) . The nontailored group daily calcium intake increased from 587.91 to 916.30 mg ( t = −3.541 ; df = 100 ; p = .001 ) ; there was no significant difference between the groups . Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise . CONCLUSION Tailored interventions  increased women 's perceived barriers to calcium and exercise . Both groups increased calcium intake . The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study . This important intervention has implication s for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis Chinese-American women have a high risk of osteoporosis . However , their calcium intake has been reported previously as considerably below the Dietary Reference Intake . Increasing consumption of calcium-rich foods , many of which are also fortified with vitamin D , is a safe way to increase their calcium and vitamin D intake . This study 's objective was to pilot-test an intervention to help Chinese-American women incorporate calcium-rich foods into their diet . This intervention was evaluated using a quasi-experimental study with a nested design and pre- , immediate post- , and 3-month follow-up assessment s.  Calcium and vitamin D intake , Theory of Planned Behavior constructs , and knowledge were measured at three time points . First-generation Chinese-American mothers between 35 and 55 years old ( n=141 ) were recruited from six weekend Chinese schools . Three Chinese schools each were r and omly assigned to the experimental ( n=71 ) or control group ( n=70 ) . The experimental group received a free heel scan and six weekly interactive lessons design ed based on the Theory of Planned Behavior . The control group received six weekly nonrelated financial lessons by mail . Changes for each measure were assessed by linear mixed model with repeated measures adjusted for confounding variables . Compared to the control group , the experimental group improved all measures considerably , except two subjective norm constructs ( normative belief and motivation to comply ) at post- assessment s. The experimental group significantly increased its baseline calcium ( t=7.898 , P<0.001 ) and vitamin D intake ( t=6.609 ; P<0.001 ) at posttest and this increase was retained at follow-up . Results suggest that this theory-based intervention is effective for increasing the dietary calcium and vitamin D intake of Chinese-American women Purpose . This study examined the effects of brief written educational material s on osteoporosis-related knowledge , beliefs , and behaviors . The study also examined whether observed effects varied as a function of one 's stage in the pre caution adoption process . Design . The study used an experimental research design . Setting . Participants were identified from North Carolina driver 's license records . Subjects . Of the 1476 women in the initial sample , 536 ( 36.3 % ) enrolled in the study and 307 completed all follow-up assessment s. Intervention . Participants were r and omly assigned to one of four groups . One group received an information packet containing general information about osteoporosis . One group received an action plan packet containing instructions on how to increase one 's level of exercise and calcium intake .  One group received both packets . The final group received neither packet . Measures . Primary study variables were beliefs related to osteoporosis , calcium , and exercise ; osteoporosis knowledge ; calcium and exercise stage ; calcium intake ; and exercise level . Results . Overall , receipt of the information packet was associated with changes in knowledge and beliefs ( F[18,283 ] = 2.11 , p < .01 ) irrespective of participants ' stage of change . No effects on behavior were observed . Conclusions . These findings suggest that brief written educational material s can facilitate knowledge and belief change but that they do not promote behavior change . The generalizability of these findings is limited by the low study response rate Purpose . This study evaluated whether a combined behavioral and dietary intervention would affect young women 's  calcium intake and bone mineral content ( BMC ) . Design . The design was a two by three mixed design with one between-subjects factor ( treatment vs. control ) and one within-subjects factor ( time — baseline , 3-month , and 6-month ) . Setting . The study was conducted in a university setting in Memphis , Tennessee . Participants . A total of 80 premenopausal women ( ages 18 to 30 ) with low baseline calcium intake ( < 700 mg/d ) were included in the analyses . There were 40 women in the treatment group and 40 women in the control group . Measures . Hertzler and Frary 's rapid assessment question naire was employed to evaluate calcium intake , and dual-energy x-ray absorptiometry ( DEXA ) was employed to assess BMC . Results . Repeated measures analysis of variance ( RM ANOVA ) was employed to analyze results . Results indicated that women in the treatment group made greater increases in total calcium intake and supplemental calcium than women in the control group and that all women made significant increases in dietary calcium intake . Additionally , analyses of BMC revealed that women in the treatment group did not experience significant changes in total BMC , and women in the control group experienced significant losses in total BMC . Conclusions . In the current study , women were losing BMC , and the women who made the largest increases in calcium intake were able to retard this bone loss . There is increasing evidence that dietary calcium intake in young people is extremely low , and the results of the current study highlight the need for much more intensive evaluations investigating the factors that are positively associated with premenopausal bone mineral change
target: Results indicate health behavior change is more likely to occur when patient-centered interventions design ed to increase knowledge and health beliefs , skills and abilities  , and  social facilitation  are delivered over time .
background: Little is known about the dimensions of osteoporosis prevention programs essential to changing health behaviors .
  The purpose of this review was to determine the impact of select characteristics of structured osteoporosis prevention programs on calcium intake in women .