title: Health behaviors in breast cancer survivors experiencing bone loss.
abstract: OBJECTIVE
  To describe the baseline healthy lifestyle behaviors (dietary, calcium, vitamin D, caffeine and alcohol intake, smoking history, and physical activity) of postmenopausal breast cancer survivors (BCS); and to identify any relationship of healthy lifestyle behaviors with bone mineral density (BMD) at the forearm, total hip and spine, L1-L4.
  
  
  METHODS
  Self-reported responses to a demographic and health status questionnaire, to a 3-day Diet Record, and to the 7-Day Physical Activity Questionnaire-Adapted provided data for the lifestyle behaviors. Baseline BMD (g/cm(2)) was determined with dual-energy x-ray absorptiometry (DEXA). Height, weight, and body mass index (BMI) were also measured in each of the 249 postmenopausal BCS.
  
  
  CONCLUSIONS
  There was an imbalance between consumed kilocalories and expenditure of energy. The majority of BCS were overweight or obese. They consumed less fruit and vegetable servings than recommended by the new 2005 U.S. Department of Agriculture's dietary guidelines, less dairy products, below average recommended grains and fiber, less protein and carbohydrate intake, and a slightly higher fat gram intake. Approximately, 43% did not take any supplemental calcium, with 46% taking less than 1000 mg a day. Likewise, 52.59% consumed less than 400 IU of vitamin D with both supplemental and dietary intake. This group of BCS consumed below accepted levels of caffeine and alcohol. Only 18 BCS continued to smoke. This group spent an average of 10.36 h in light (sedentary) activities on a daily basis. There were significant negative relationships with bone mass (g/cm(2)) at the total hip and daily intake of caffeine/mg and daily grams of alcohol. Weight and BMI both demonstrated a significant relationship with bone mass (g/cm(2)) at the total hip, spine L1-L4, and the forearm.
  
  
  CONCLUSIONS
  The healthcare provider must incorporate appropriate teaching strategies, intensive counseling, and coaching, along with a support mechanism, to enable BCS to understand the importance of a healthy diet, calcium, and vitamin D supplement, and a regular strength/weight program that will be integrated into their daily lifestyle. Early DEXA screens should be part of the protocol with BCS, and there is a particular need for forearm DEXA screens to be included in the treatment protocol for BCS.
authors.affiliation: Omaha Division, University of Nebraska Medical Center College of Nursing, Omaha, Nebraska 68198-5330, USA. jtwiss@unmc.edu
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Twiss
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Gross
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Waltman
authors.forename: Carol D
authors.initials: CD
authors.lastname: Ott
authors.forename: Ada M
authors.initials: AM
authors.lastname: Lindsey
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000150:complications*; D002110:Caffeine; D002136:Calcium, Dietary / Q000008:administration & dosage; D002149:Energy Intake; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D015146:Midwestern United States; D009765:Obesity / Q000150:complications; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D012648:Self Care / Q000379:methods / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
chemical_list: D002136:Calcium, Dietary; D002110:Caffeine