Knowledge about osteoporosis: assessment, correlates and outcomes

Assessing osteoporosis awareness and knowledge levels of Turkish multiple sclerosis patients: an observational study

This study assessed osteoporosis knowledge and awareness among multiple sclerosis patients. The findings reveal a concerning lack of knowledge and awareness regarding osteoporosis, emphasizing the necessity for educational interventions to enhance early detection and mitigate complications within this particular patient group.

AIM

To assess the knowledge and awareness of osteoporosis in Turkish multiple sclerosis (MS) patients.

MATERIAL-METHODS

Three hundred twenty-five patients were asked to fill out the osteoporosis awareness scale (OAS), which has a scoring range of 31-124, and the revised osteoporosis knowledge test (R-OKT), which has a score range of 0-32. Fall risk assessment for patients was conducted using the timed up-and-go test (high risk: > 30, moderate risk: 29-20, low risk: 14-19, and no risk: < 13 s).

RESULTS

An average score of 59.42 ± 19.63(31%) on the OAS and 14.99 ± 5.39 (47%) on the R-OKT was detected. No difference was found in R-OKT scores between genders, education levels, and patients with different fall risks and between genders and education levels in OAS scores. Patients with low, medium, and high fall risks exhibited higher OAS scores compared to those without any fall risk (p = 0.006, p < 0.001, and p < 0.001, respectively). No correlation was found between gender and education level with OAS and R-OKT scores and between the R-OKT scores and the risk of falls. There was a weak correlation between the OAS scores and an increased risk of falls (r = 0.269, p < 0.001). No differences between the age groups regarding OAS and R-OKT scores were observed.

CONCLUSIONS

Turkish MS patients have inadequate knowledge and low awareness of OP compared to the healthy population. Urgent action is warranted to educate and support individuals with MS, implementing targeted interventions and awareness campaigns to improve early detection and prevent osteoporosis-related complications.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05760651.

Knowledge and Awareness of Osteoporosis: A Survey of Physical Therapy Providers in Saudi Arabia

Background

Osteoporosis "OP" is classified as one of the most serious health conditions worldwide. OP increases the skeletal fracture risk by 35%, particularly at hip, spine, and wrist joints. Healthcare professionals should be aware of OP clinical signs and have good knowledge while managing all patients.

Objectives

This study aims to investigate the current level of osteoporosis knowledge and awareness among physical therapy providers in Saudi Arabia.

Methods

One hundred and sixty-eight physical therapy providers participated in this cross-sectional electronic survey from February to July of 2021. The participants completed the Osteoporosis Knowledge Assessment Tool questionnaire (OKAT). Descriptive analysis was utilized to assess the current level of osteoporosis knowledge among physical therapy providers.

Results

Among the 168 participants, 55% (n = 92) were over 31 years old and 45% (n = 76) were 30 years old or under. The majority of participants 37% (n = 62) had more than 10 years of experience, 45% (n = 76) mainly treat orthopedic conditions, and 70% (n = 117) live in the western region. The results showed that 67.9% (n = 114) of participants had good knowledge about osteoporosis, while 19.6% (n = 33) had poor knowledge, and only 12.5% (n = 21) had excellent knowledge.

Conclusion

Physical therapy providers in Saudi Arabia have a good knowledge of osteoporosis. The overall OP preventive measure knowledge questions were poor. It is crucial for physical therapy providers to act appropriately to prevent falls and mitigate any potential risks.

Economic and Humanistic Burden Among Medicare-Aged Women With Fragility Fracture in the United States

OBJECTIVE

Describe patient characteristics, health care resource utilization, costs, and humanistic burden of women with Medicare insurance with incident fragility fracture who were admitted to post-acute-care (PAC).

DESIGN

Retrospective cohort study using 100% Medicare Fee-for-Service (FFS) data.

SETTING AND PARTICIPANTS

Community-dwelling female Medicare beneficiaries with incident fragility fracture January 1, 2017, to October 17, 2019, resulting in PAC admission to a skilled nursing facility (SNF), home-health care, inpatient-rehabilitation facility, or long-term acute-care hospital.

METHODS

Patient demographic/clinical characteristics were measured during 1-year baseline. Resource utilization and costs were measured during baseline, PAC event, and PAC follow-up. Humanistic burden was measured among SNF patients with linked Minimum Data Set assessments. Multivariable regression examined predictors of PAC costs after discharge and changes in functional status during SNF stay.

RESULTS

A total of 388,732 patients were included. Compared with baseline, hospitalization rates were 3.5, 2.4, 2.6, and 3.1 times higher and total costs 2.7, 2.0, 2.5, and 3.6 times higher for SNF, home-health, inpatient-rehabilitation, and long-term acute-care, respectively, following PAC discharge. Utilization of dual-energy X-ray absorptiometry (DXA) and osteoporosis medications remained low: 8.5% to 13.7% received DXA during baseline vs 5.2% to 15.6% following PAC; 10.2% to 12.0% received osteoporosis medication during baseline vs 11.4% to 22.3% following PAC. Dual eligibility for Medicaid (ie, low income) was associated with 12% higher costs; Black patients had 14% higher costs. Activities of daily living scores improved 3.5 points during SNF stay, but Black patients had 1.22-point lower improvement than White patients. Pain intensity scores showed small improvement (-0.8 points).

CONCLUSIONS AND IMPLICATIONS

Women admitted to PAC with incident fracture had high humanistic burden with little improvement in pain and functional status and significantly higher economic burden after discharge compared with baseline. Disparities in outcomes related to social risk factors were observed, with consistently low utilization of DXA and osteoporosis medications even after fracture. Results indicate a need for improved early diagnosis and aggressive disease management to prevent and treat fragility fractures.

Development and Validation of India-specific Hindi Version of Osteoporosis Knowledge Assessment Tool

Purpose

Patient education is one of the important components of reducing the morbidity of osteoporosis. The aim of this study is to validate the Hindi version of the Osteoporosis Knowledge Assessment Tool (OKAT-H) among a hospital-based sample in the age group of 18-44 years of age.

Methods

The study was conducted in two phases - translation and adaption of the OKAT in Hindi followed by its validation. The translated tool was analyzed by Flesch reading ease, McNemar test, Cronbach alpha, difficulty index, discrimination index, and principal factor analysis.

Results

Two hundred and sixty women with a mean age of 28.3 ± 17.2 years were enrolled in the study. The mean score of the OKAT-H tool obtained in the study was 11.3 ± 2.1. A significant difference was noted in the scores based on educational qualification or with any family history of either osteoporosis or fracture (P < 0.05). The Flesch score for the OKAT-H tool was 86. Inter-item correlation for all the items ranged between 0.15 and 0.5. The Cronbach's alpha measured 0.892 suggesting high internal consistency. Items number 6, 7, 8, 9, 13, and 14 showed a significant difference on the McNemar test questioning its consistency on test-retest.

Conclusion

A new shorter version of the tool may be developed since six items showed low consistency. The use of such an instrument in local language would help spread awareness about the disease as well as help the population in adopting osteoprotective strategies and also to seek help and advice regarding treatment.

Perception and awareness of osteoporosis and its related risk factors among women: A cross-sectional study

<b>Objectives:</b> This study was designed to assess the awareness of women of the risk factors and preventive measures of osteoporosis.<br /> <b>Methods:</b> This is a cross-sectional study that was conducted in Jordan. During the study period, a convenience sample of women were invited to participate via a survey link communicated through social media. Linear regression was used to screen independent variables affecting participants’ awareness of osteoporosis, its risk factors, and preventive measures.<br /> <b>Results:</b> 426 women agreed to participate in this study, with a median age of 38.5 years (IQR=16.0). Results showed that women have a median awareness score of 5.0 out of 9.0 (IQR=4.0) about osteoporosis risk factors, whereas women with higher educational levels (diploma or higher) and those with medical-related degrees have a higher awareness about osteoporosis risk factors compared to others (p≤0.05).<br /> Medical websites were the primary source used to obtain information about osteoporosis by the participating women (n=236, 55.4%). Also, results showed that more than 90% of the women believed that osteoporosis is a chronic silent disease that makes your bones less dense and more fragile (n=418, 98.1%), and that bone strength may increase by taking vitamin D and calcium (n=405, 95.0%).<br /> <b>Conclusion:</b> This study showed that women had an intermediate level of awareness of osteoporosis and prevention measures. The importance of medical websites and social media as sources of information was also demonstrated. More public targeted campaigns are needed to promote awareness of osteoporosis, its risk factors, prevention, and treatment.

Knowledge and understanding risk factors and preventive measures for osteoporosis in women: results of a survey in 502 women with and without a migration background

BACKGROUND

Osteoporosis is a disease of the skeletal system associated with loss of bone mass and an increased risk of fractures affecting women more often than men. Identification of the knowledge about osteoporosis and its preventive methods is the backbone of any awareness program. This study investigates the knowledge with a special focus on women with and without a migration background.

METHODS

Data from systematic patient interviews based on a questionnaire were collected at three different sites in Berlin between February and June 2021. The survey included questions assessing migrant background, demographic characteristics, lifestyle habits including physical exercise and smoking, prevention by vitamin D intake and bone densitometry, and information on personal and family medical history. According to the responses, a scale was created to assess the level of knowledge of preventive osteoporosis measures. The ethic committee of the Charité, Medical faculty has approved this study. SPSS (version 24.0) was used for the statistical analyses.

RESULTS

The survey of 502 female patients revealed that 25% had low and 34% no previous knowledge of osteoporosis. Older age and a better education level correlate with a higher knowledge. Patients with gynecologic cancer are less well informed. There is a significant difference in vitamin D intake between migrant and non-migrant women (57% vs. 49%). There were no significant differences regarding the use of bone densitometry.

CONCLUSION

Knowledge of osteoporosis and the possibility of a bone densitometry as well as the implementation of preventive measures is low among women. Therefore, informing patients better should be a priority, with particular attention on the risks and needs of women with a migration background. Specific programs for women with and without migration background should be developed to increase the awareness of osteoporosis.

Evaluate Postmenopausal Women’s Knowledge of Osteoporosis Prevention at Specific hospital, Kancheepuram

Background: Osteoporosis is a disease that changes with time. It’s a serious bone condition marked by brittle bones. Thickness, less technical degradation of bone tissue, and consequent increased bone plasticity, greatly increasing the risk of fractures bone. Osteoporosis is a public health issue affecting 200 million women worldwide each year. Objectives: Evaluate postmenopausal women’s knowledge of osteoporosis prevention. Methodology: Quantitative approach with descriptive research design. Independent variable is self-structured inquiry and dependent variable is Knowledge of postmenopausal women. The study was conducted at kancheepuram district. Sample includes post-menopausal who fulfils the inclusion criteria were selected by convenient sampling technique. Results:osteoporosis among postmenopausal women was 11.82 with standard deviation 4.57 with maximum score of 20.0. The calculated statistically highly significant at p<0.05 level. Summary: The analysis shows there is no association with the level of knowledge among osteoporosis in post-menopausal women.

Meta-Learning Analysis of Ultrasonic Guided Waves for Coated Cortical Bone Characterization

Due to its sensitivity to geometrical and mechanical properties of waveguides, ultrasonic guided waves (UGWs) propagating in cortical bones play an important role in the early diagnosis of osteoporosis. However, as impacts of overlaid soft tissues are complex, it remains challenging to retrieve bone properties accurately. Meta-learning, i.e., learning to learn, is capable of extracting transferable features from a few data and, thus, suitable to capture potential characteristics, leading to accurate bone assessment. In this study, we investigate the feasibility to apply the multichannel identification neural network (MCINN) to estimate the thickness and bulk velocities of coated cortical bone. It minimizes the effects of soft tissue by extracting specific features of UGW, which shares the same cortical properties, while the overlaid soft tissue varies. Distinguished from most reported methods, this work moves from the hand-design inversion scheme to data-driven assessment by automatically mapping features of UGW to the space of bone properties. The MCINN was trained and validated using simulated datasets produced by the finite-difference time-domain (FDTD) method and then applied to experimental data obtained from cortical bovine bone plates overlaid with soft tissue mimics. A good match was found between experimental trajectories and theoretical dispersion curves. The results demonstrated that the proposed method was feasible to assess the thickness of coated cortical bone plates.

Osteoporosis knowledge, health beliefs, and self-efficacy in Hong Kong Chinese men

A total of 277 Hong Kong Chinese men participated in this prospective cohort study. Their osteoporosis knowledge was average. Their perceived susceptibility to osteoporosis was low. Barriers to lifestyle modifications were the strongest predictor for self-efficacy in adopting these activities. These results are useful for planning osteoporosis public awareness campaigns for men.

PURPOSE

Male osteoporosis had long been neglected despite one-third of fractures occurring in men. Lifestyle modification through education is the main tactic in osteoporosis prevention, but current programs and strategies are designed for postmenopausal women. Understanding men's knowledge, health belief, and self-efficacy in adopting osteoporosis prevention strategies can help to design a specific program for men.

METHODS

A prospective cohort study was conducted in three men's health clinics in Hong Kong from September to October 2020, recruiting 277 men aged ≥ 20 years. They completed a questionnaire consisting of sociodemographic data, 14 general questions from the Facts on Osteoporosis Quiz (FOOQ), Male Osteoporosis Knowledge Quiz (MOKQ), Osteoporosis Health Belief Scale (OHBS), and Osteoporosis Self-Efficacy Scale (OSES). Scores from these scales and their association with sociodemographic data were reported. Correlations between age, knowledge, health beliefs, and self-efficacy were studied using the Health Belief Model.

RESULTS

The mean age was 36.4 years old, and 52% had university education. Their mean FOOQ + MOKQ score was 10.8 out of 20; mean OHBS score was 129.2 out of 210; and mean OSE-Exercise and OSE-Calcium scores were 66.4 and 68.9 out of 100 respectively. Self-efficacy of exercise was correlated with young age, perceived exercise benefits, and little barriers to exercise (p < 0.01). Self-efficacy of calcium intake was positively correlated with health motivation and self-efficacy of exercise and negatively correlated with barriers to calcium intake (p < 0.01).

CONCLUSION

Male osteoporosis awareness programs should focus on improving knowledge, enhancing awareness on susceptibility, promoting benefits of lifestyle modification, and helping men overcome perceived barriers.

Osteoporosis guideline awareness among Iranian nurses: results of a knowledge and attitudes survey

Introduction

Osteoporosis is a chronic and progressive disease associated with gradual bone loss and elevated risk of fracture. Role of health care professional especially nurses in lowering burden of osteoporosis via patients and public education is critical. Current study conducted to evaluate knowledge and attitude regarding osteoporosis among the nurses in orthopedic wards and their experience with national clinical osteoporosis guideline.

Methods

A cross-sectional study was conducted from August to December 2016 among all nurses in orthopedic ward of hospitals affiliated to Shiraz University of Medical Sciences. The 23- item self-administered scale consisted of knowledge and attitude questions were used. Moreover, data regarding participation in osteoporosis training courses and awareness of the national osteoporosis clinical guideline were collected as a measure of nurses’ experience with guideline. The gathered data were analyzed using SPSS (V. 16), student t-test was used to compare total knowledge and attitude scores between categorical demographic and professional data. Pearson test was used to calculate the correlation between total knowledge and attitude scores and years of practice. A p-value < 0.05 was considered statistically significant.

Results

From total of 160 nurses, 143 of them completed the questionnaire (response rate: 89.3%). The total mean ± SD knowledge and attitude scores were 11.60 ± 3.10 and 3.47 ± 0.92 respectively. Six nurses (4.2%) had participated in osteoporosis training courses after graduation, and 39 (27.3%) had been aware of the national osteoporosis clinical guideline. Knowledge and attitude scores among nurses who practice in private hospitals was higher than those practices in the teaching hospitals. These differences were statistically significant based on student t-test. According to Pearson correlation coefficient, there was positive and significant correlation between nurses’ knowledge and attitude score (Correlation coefficient: 0.199, p-value = 0.037).

Conclusion

Our findings reveal that nurses’ knowledge and attitude regarding osteoporosis was not satisfactory. Most of them were not aware of national osteoporosis clinical guideline and had not participated in osteoporosis training courses after their graduation. We need more empowered nurses to lowering burden of osteoporosis and its consequences in the future.

Knowledge, health belief, and associated factors towards the prevention of osteoporosis among post-menopausal women in Metu Town, southwest Ethiopia: A community-based cross-sectional study

INTRODUCTION

Osteoporosis is a condition where bones lose mass and strength. It is a common cause of morbidity and mortality in women, especially those of post-menopausal age. It is estimated that 30% of postmenopausal women globally suffer from osteoporosis. This study aimed to assess knowledge, health beliefs, and associated factors towards the prevention of osteoporosis among post-menopausal women in Metu Town, southwest Ethiopia, 2021.

METHODS

A community-based cross-sectional study was conducted among 422 post-menopause women. A simple random sampling technique was employed to select study participants. Data was collected using a structured interviewer-administered questionnaire. Bivariate and multivariate analyses were condcuted to identify factors significantly associated with the outcome variable.

RESULTS

The results showed that 38.4% and 44.5% of participants had adequate knowledge and positive health beliefs towards the prevention of osteoporosis. Age, marital status, educational status, employment status, and self and family history of osteoporosis were significantly associated with knowledge. Age, educational status, self and family history of osteoporosis, and sources of information were significantly associated with health beliefs.

CONCLUSION

More than 40% of participants had adequate knowledge and positive health beliefs. Being younger, better educated, and having a personal and family history of osteoporosis increased the odds of having adequate knowledge and positive health beliefs. Being employed and getting information from families and friends had a significant association with higher odds of adequate knowledge and positive health beliefs.

To study the awareness of osteoporosis in postmenopausal Indian women in a Northeast part of India: An evaluation of the Osteoporosis Health Belief Scale

Aim and Objective:

Our study's objective is to determine the level of awareness in postmenopausal women in Guwahati, Northeast part of India, using the Osteoporosis Health Belief Scale (OHBS).

Settings and Design:

Osteoporosis is the most common silent health problem in postmenopausal Indian women. An awareness level among this subset of women needs to study. The present study is based on a self-explanatory questionnaire.

Methods:

We conducted a self-explanatory questionnaire study on 2000 postmenopausal women in Guwahati, North East region of India. The bone mineral density (BMD) was measured using calcaneum Quantitative ultrasound (QUS) to assess BMD. Baseline characteristics were noted and analyzed.

Results:

The awareness level was noted only in757 (37.85%). Women with education level 12^th standard and above have some awareness regarding osteoporosis.

Conclusions:

Based on the present study, we can conclude that there is a lack of awareness in postmenopausal women regarding osteoporosis in India's North-East region. This subset of women is unaware of the condition that can leads to fragility fracture if not address in time. The study emphasizes that health care professionals should conduct frequent awareness programs in the community to prevent this silent disease, and morbidities so arise from osteoporosis can be minimized.

Assessment of osteoporosis knowledge among adult Saudi females attending the family medicine department at Security Forces Hospital, Riyadh, Saudi Arabia

Background

Osteoporosis is a skeletal disorder characterized by loss of bone mineral density, deterioration of bone structure, bone fragility, and it is associated with high risk of fractures. The prevalence of osteoporosis among Saudis is estimated to be 34% in females and 30.7% in males. The aim of this study was to know the level of knowledge about osteoporosis among Saudi females at Security Forces Hospital, Riyadh, Saudi Arabia.

Materials and Methods

This was a descriptive and analytical cross-sectional study conducted between January 2019 and January 2020. We used the osteoporosis knowledge assessment tool (OKAT) for data collection. The survey assessed the understanding of symptoms and fracture risk, risk factors, treatment availability and preventive factors for osteoporosis.

Results

The overall knowledge of our 376 participants was good with a mean score of (66%). Participants had more knowledge about the symptoms and fracture risk and the preventive factors such as physical activity and diet compared to the other subscales of the OKAT. There was a significant difference between the knowledge of younger and older females (>40 yrs.), where younger females had lower scores on the OKAT.

Conclusion

This study showed that knowledge about osteoporosis was good among females attending the family medicine clinics in Riyadh, Saudi Arabia. However, younger females were less knowledgeable, which means that more effort should be made to increase the awareness about osteoporosis especially among the younger females.

Knowledge and Beliefs on Osteoporosis among African Postmenopausal Women in a Kenyan Semi-Rural County of Kiambu

BACKGROUND

Assessing people's knowledge and beliefs about osteoporosis is fundamental to the formulation of preventive strategies for this condition. To our knowledge, no randomized community survey has been conducted using Facts on Osteoporosis Quiz (FOOQ) and Osteoporosis Health Belief Scale (OHBS) exclusively in the postmenopausal women in Kenya. This study aimed to assess postmenopausal women&apos;s knowledge and beliefs concerning osteoporosis in semirural Kiambu County, Kenya.

METHODS

A cross-sectional study involving face-to-face interviews with 254 African postmenopausal women was conducted between October 2017 and February 2018. The questionnaire explored the socio-demographic characteristics; FOOQ was used to evaluate the knowledge these women had about osteoporosis, while OHBS was used to assess their beliefs.

RESULTS

The mean age of the participants was 64.6±10.7 years. About 26.4% (67/254) of the participants had no formal education, while 3.1% (8/254) were in formal employment. About 54.3% (138/254) of the women were married, and 51.2% (130/254) were in the lowest and lower wealth quintile. FOOQ had a mean score of 8.6 (standard deviation±1.8; range, 0-17). OHBS revealed a low level of perceived susceptibility to osteoporosis. Perceived benefits of exercising and calcium intake as well as perceived seriousness of osteoporosis as a disease were at moderate levels. The level of health motivation was also moderate.

CONCLUSIONS

The women in this study demonstrated limited knowledge about osteoporosis. The low susceptibility score makes the prevention and treatment of osteoporosis in this population challenging. We recommend public health education for all postmenopausal women in this setting.

Ambiguity hindering self-management and prevention of osteoporosis in post-menopausal women

As osteoporosis relies largely on self-managed prevention and adherence to long-term treatment regimens, it is imperative that those at risk understand the disease that they are attempting to prevent. Ambiguity regarding osteoporosis and reluctance to take anti-osteoporosis medication (AOM) as well as calcium was noted in Australian post-menopausal women. This may lead to underestimating women's own risk of osteoporosis and fracture.

INTRODUCTION

Fragility fractures caused by osteoporosis have been known to inflict significant personal and financial burden on individuals and society. As treatment of osteoporosis relies largely on self-managed prevention and adherence to long-term AOM regimens, it is imperative that women have a sound understanding of the disease that they are attempting to prevent. Much can also be gained from qualitatively exploring the level of osteoporosis knowledge particularly in post-menopausal women who are at greater risk of osteoporosis and fractures. This study thus aims to determine what post-menopausal Australian women know about osteoporosis and osteoporosis prevention.

METHOD

Six focus group sessions, using purposive sampling, were conducted with 23 female participants (mean age 68 years (range 62-83)). Women responded to a series of open-ended questions regarding their knowledge about osteoporosis. The audiotaped focus groups were transcribed verbatim and analysed using a thematic analysis framework.

RESULTS

Three key themes were identified: ambiguity about the nature of osteoporosis, ambiguity about osteoporosis prevention and reluctance to take AOM and calcium.

CONCLUSION

Ambiguity associated with risk and prevention may provide women with a false sense of security that they are adequately acting to prevent the disease. Underestimation of their risk of osteoporosis and fracture as well as reluctance associated with AOM may be barriers to osteoporotic fracture prevention.

What Messages About Osteoporosis Are Offered in Spanish Videos on YouTube?

OBJECTIVE

The aim of this study was to determine the appropriateness of messages on osteoporosis in Spanish videos posted on YouTube.

METHODS

YouTube Spanish language videos on osteoporosis were evaluated. The main variable was the presence of appropriate messages related to osteoporosis. The content was evaluated through a checklist based on available guidelines and reviewed by an expert (E.C.L.). The evaluation was performed twice independently for each video. A discussion of discordant messages was made with the expert. Other variables included were number of views, comments, "likes," and "dislikes"; the total duration of the video; and their source (health professionals and non-health professionals). Bivariate analysis between health professionals and non-health professionals were performed using the Mann-Whitney U and the χ tests.

RESULTS

A total of 148 videos were reviewed. The median appropriate score for all videos was 5 (p25: 3, p75: 9) (maximum possible, 29 points). Seventy-three (49%) videos had a health professional as source, 124 (83.8%) mentioned at least one message in the definition area, 99 (66.9%) in the area of diagnosis, 99 (66.9%) in the area of recommendations, 43 (29.1%) in the area of treatment, and 5 (3.4%) in follow-up. The most frequent message was "risk of fracture" (68.9%).

CONCLUSIONS

The content of osteoporosis information found in YouTube was generally incomplete and inaccurate. The content of these videos should include treatment and preventive strategies.

Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies

Background

Patients with low bone density or osteoporosis need information for effective prevention or disease management, respectively. However, patients may not be getting enough information from their primary care providers or other sources. Inadequate disease information leaves patients ill-informed and creates misconceptions and unnecessary concerns about the disease.

Objective

We systematically reviewed and synthesized the available literature to determine patient knowledge, beliefs, and concerns about osteoporosis and identify potential gaps in knowledge.

Methods

A systematic search was conducted for full-text qualitative studies addressing understanding, literacy, and/or perceptions about osteoporosis and its management, using Medline, EMBASE, Web of Science, Cochrane Library, CINAHL, ERIC, PsychINFO, Psyc Behav Sci Collec, and PubMed, from inception through September 2016. Studies were selected by two reviewers, assessed for quality, and themes extracted using the Joanna Briggs Institute data extraction tool. Thematic analysis was used to identify themes and subthemes.

Results

Twenty-five studies with a total of 757 participants (including 105 men) were selected for analysis out of 1031 unique citations. Selected studies were from Australia, Canada, Denmark, Norway, the United Kingdom, and the United States. Four main themes emerged: inadequate knowledge, beliefs and misconceptions, concerns about osteoporosis, and lack of information from health care providers. Participants had inadequate knowledge about osteoporosis and were particularly uninformed about risk factors, causes, treatment, and prevention. Areas of concern for participants included diagnosis, medication side effects, and inadequate information from primary care providers.

Conclusion

Although there was general awareness of osteoporosis, many misconceptions and concerns were evident. Education on bone health needs to reinforce areas of knowledge and address deficits, misconceptions, and concerns.

Identifying and addressing osteoporosis knowledge gaps in women with premature ovarian insufficiency and early menopause: A mixed-methods study

OBJECTIVE

Osteoporosis associated with premature ovarian insufficiency (POI) and early menopause (EM) is a major concern for women. We aimed to (a) identify information and knowledge gaps and behaviours regarding bone health in women with POI/EM and (b) co-design an osteoporosis fact sheet.

DESIGN

Mixed-methods study: survey of women and online resource appraisals to develop and refine, using semi-structured interviews, an osteoporosis fact sheet.

PATIENTS

Women with POI/EM (menopause before ages 40 and 45 years respectively).

MEASUREMENTS

Demographics, comorbidities, information needs, calcium intake, exercise, osteoporosis knowledge (OKAT), beliefs and self-efficacy, DISCERN appraisal (validated scales).

ANALYSIS

descriptive statistics, logistic regression and thematic analysis of interviews.

RESULTS

Median age of survey respondents (n = 316) was 54(IQR47-63) years, median age of menopause was 40(IQR38-43) years, and osteoporosis diagnosis was reported in 19%. Most reported inadequate dietary calcium intake (99%) and exercise (65%). Median OKAT score 8 [IQR6-10]/19 indicated knowledge gaps regarding risk factors and treatment options. Adjusting for age and education, OKAT predicted calcium intake (OR 1.126 [CI 1.035-1.225]; P = 0.006) and screening (OR 1.186 [CI 1.077-1.305]; P = 0.001); beliefs predicted screening (OR 1.027 [CI 1.004-1.050]; P = 0.019); and self-efficacy predicted calcium intake (OR1.040 (CI 1.013-1.069); P = 0.003] and exercise (OR 1.117 [CI 1.077-1.160]; P < 0.001). Current online resources have deficiencies. Five themes identified from two interview rounds (n = 10/ round) were as follows: content, emotional response, design, perceived usefulness and clinical considerations. The final fact sheet was considered acceptable and useful in addressing knowledge gaps, promoting information-seeking, impacting behaviours and facilitating healthcare discussions.

CONCLUSION

A co-designed fact sheet is acceptable and addresses identified osteoporosis knowledge gaps in women with POI/EM.

Nonlinear Inversion of Ultrasonic Dispersion Curves for Cortical Bone Thickness and Elastic Velocities

In this study, a nonlinear grid-search inversion has been developed to estimate the thickness and elastic velocities of long cortical bones, which are important determinants of bone strength, from axially-transmitted ultrasonic data. The inversion scheme is formulated in the dispersive frequency-phase velocity domain to recover bone properties. The method uses ultrasonic guided waves to retrieve overlying soft tissue thickness, cortical thickness, compressional, and shear-wave velocities of the cortex. The inversion strategy requires systematic examination of a large set of trial dispersion-curve solutions within a pre-defined model space to match the data with minimum cost in a least-squares sense. The theoretical dispersion curves required to solve the inverse problem are computed for bilayered bone models using a semi-analytical finite-element method. The feasibility of the proposed approach was demonstrated by the numerically simulated data for a 1 mm soft tissue-5 mm bone bilayer and ex-vivo data from a bovine femur plate with an overlying 2 mm-thick soft-tissue mimic. The bootstrap method was employed to evaluate the inversion uncertainty and stability. Our results have shown that the cortical thickness and wave speeds could be recovered with fair accuracy.

Osteoporosis awareness and health beliefs among Lebanese women aged 40 years and above

Our study investigated the characteristics of Lebanese women population groups with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures in order to identify categories that should be targeted in future campaigns and educational programs. Higher knowledge scores were reached in women who already heard about the disease and had a formal education. As a result, osteoporosis awareness campaigns and educational programs are mostly needed in populations with lower educational levels.

INTRODUCTION

Our study investigated the characteristics of Lebanese women population groups with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures.

METHODS

A cross-sectional study, conducted between March and June 2018, enrolled 560 community dwelling women aged 40 years and above. A questionnaire was used to collect data. A proportionate random sample from all Lebanese Mohafazat was used. Data collection was performed through personal interviews. The median was used as a cutoff point for both the Knowledge and Health Belief scales.

RESULTS

The study results showed that 47.3% of participants had a poor knowledge score. Women who received no education, compared to a higher education and have not previously heard about the disease, had lower knowledge scores. In addition, women not taking calcium and vitamin D supplements and not exercising or exercising less than 20 min per day compared to those having these characteristics had lower osteoporosis knowledge levels. A lower knowledge score was associated with less recognized benefits of adequate calcium intake and regular physical activity, more perceived barriers towards their practice, and a less important health motivation. A lower level of education correlated to the same results.

CONCLUSION

Lower knowledge scores were reached in women who have never heard of osteoporosis and had a lower level of education. As a result, osteoporosis awareness campaigns and educational programs need to target population categories with lower educational levels.

Cross-Cultural Adaptation and Psychometric Properties of Osteoporosis Knowledge Tool-Arabic Version Among Iraqi Population

Background:

Osteoporosis is a major public health problem as the majority of people are not aware of the disease until the complications occur.

Objective:

The aims of this study were to validate Osteoporosis Knowledge Tool (OKT-A) Arabic version and to assess the osteoporosis knowledge among Iraqi general population.

Methods:

A descriptive, cross-sectional study was carried out in the city of Baghdad with a random cluster sampling method from the community. Forward–backward-forward translation method was used to translate the OKT questionnaire from English into Arabic language. The psychometric assessment process includes: face validity, reliability (Cronbach’s alpha and test-retest), item difficulty index, point biserial correlation and discriminatory power.

Results:

The results showed good face validity. The Cronbach’s alpha and Pearson correlation coefficient of the test re-test reliability were 0.775 and 0.412, respectively. Item difficulty index, point biserial correlation ranges and discriminatory power were 0.105 to 0.852, 0.105 to 0.445 and 0.933, respectively. These results demonstrated that OKT-A was a reliable and stable tool. The results showed low OKT-A scores 11.50±3.958. Furthermore, the OKT-A scores and its subscales were less than 50%. In addition, there were significant differences between the following independent variables in relation to total OKT-A scores: educational level, do you have osteoporosis or ever heard about osteoporosis. Moreover, there was a significant association between ever heard about osteoporosis groups and the OKT-A knowledge levels.

Conclusion:

This study showed good validity and reliability of OKT-A tool among Arabic general population. In addition, the results showed an urgent need for implementing an educational programme and should be a public health practice to increase the knowledge toward osteoporosis and its related risk factor.

A path analysis model suggesting the association of information and beliefs with self-efficacy in osteoporosis prevention among middle-aged and older community residents in urban Shanghai, China

BACKGROUND

Osteoporosis is a chronic disease whose prevention is more effective than treatment, but it may be necessary to change people's self-efficacy to prevent this condition. This article aimed to study the pathway among information, beliefs and self-efficacy in osteoporosis prevention, and support further intervention.

METHODS

A cross-sectional study was conducted among community residents over 40 years old from two volunteer communities in urban Shanghai, China. Of 450 middle-aged and older community residents who volunteered to participate in the study, 421 (93.5%) finished the field survey effectively.

RESULTS

62.9% of the residents were females. Their mean age was 64.4 ± 11.2 years. The residents showed low knowledge of osteoporosis-related information, and the mean percentage of correct response was just 61.2%. In univariate analysis, information (univariate β = 0.27, 95% CI = 0.15-0.38) and beliefs (univariate β = 0.31, 95% CI = 0.25-0.38) were associated with self-efficacy. Multivariate analysis showed that information (multiple β = 0.19, 95% CI = 0.09-0.36) and belief (multiple β = 0.30, 95% CI = 0.23-0.36) remained significant. And in the path analysis, self-efficacy was significantly predicted by beliefs (β = 0.81, p<0.001).

CONCLUSIONS

The study highlighted the urgency of conducting the osteoporosis preventive health promotion among middle-aged and older people as their lack of information and low level of beliefs and self-efficacy about osteoporosis prevention. Future interventions should focus on improving beliefs, especially perceived benefits, perceived threats, and action clues, on osteoporosis prevention in this group.

Low knowledge of osteoporosis and its risk factors in urban Indian adults from Pune city, India

OBJECTIVE

To assess knowledge of osteoporosis and its risk factors and to explore associations between knowledge and various sociodemographic factors in Indian adults.

DESIGN

Cross-sectional study. The Revised Osteoporosis Knowledge Test (OKT) was used to assess knowledge of osteoporosis. Four scores (OKT-total, range 0-32; OKT-exercise, range 0-20; OKT-nutrition, range 0-26; OKT-risk factors, range 0-14) were generated by giving 1 point to every correct answer and 0 points for incorrect or 'not known' answers.

SETTING

Tertiary-care hospital in Pune city, India.ParticipantsAdults aged 40-75 years (n 477; 234 males) enrolled through voluntary routine health checks and health camps.

RESULTS

Mean age of the study population was 54·6 (sd 9·5) years. Half the participants were aware of osteoporosis and could correctly define it. Women showed significantly higher median OKT-total and OKT-nutrition scores than men (P0·1).

CONCLUSIONS

Understanding about osteoporosis and its risk factors is low in the present cohort of Indian men and women. There is need to create awareness programmes aimed at both men and women especially targeting those with lower education, lower socio-economic status and no previous exposure to osteoporosis.

Knowledge of risk factors and prevention of osteoporosis: the Israeli women's health at midlife study

Wide disparities in knowledge of risk factors and prevention of osteoporosis were demonstrated among midlife Israeli minority women (Arabs and immigrants from the former USSR) compared to Jewish long-time residents. Women who believed osteoporosis to be a serious disease and those who felt susceptible to it reported better knowledge.

PURPOSE

The main goals of this study were to assess knowledge of risk factors and preventive measures for osteoporosis in middle-aged women and to evaluate the relationship of knowledge to personal risk factors and personal perceptions about osteoporosis.

METHODS

Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTJRs), immigrants from the former Soviet Union, and Arab women. The survey instrument included five knowledge statements related to the risk after menopause, the risk of smoking, family history of fractures, decreased risk by physical activity, and by use of medications.

RESULTS

The findings indicated wide disparities in knowledge about risk factors and preventive behavior of osteoporosis between the two minority groups (immigrants from the former Soviet Union and Arab women) and the majority group of midlife Israeli women. Knowledge of osteoporosis was related to perceived severity of the disease and partly to perceived susceptibility to osteoporosis. Past diagnosis of osteoporosis, current or past smoking status, and BMI were unrelated to knowledge in multivariate analyses.

CONCLUSIONS

There is a need to improve knowledge of osteoporosis especially among less educated and minority women. Subjective perception of risk was more strongly related to knowledge than actual risk factors and should be targeted in public campaigns. The efforts should be aimed at strengthening women's perception of their own susceptibility to osteoporosis and of the severity of this disease.

Knowledge and Awareness of Osteoporosis among Saudi Physicians and Nurses: A Cross-Sectional Study

AIM:

We aimed to evaluate the awareness and knowledge of osteoporosis in a sample of 141 health professionals.

MATERIALS AND METHODS:

A group of 141 health professionals (medical, surgical, primary health care and nursing departments) were enrolled in this cross-sectional study in the period from August 2017 to November 2017. The participants completed a questionnaire composed of 19 questions about osteoporosis which covering the main domains of knowledge on osteoporosis. Each correct answer carried 1 point whereas incorrect or ‘don’t know’ carried 0 points. This gave a total score range of 0-19. A cut-off level of < 10 points was considered as poor knowledge while ≥ 10 was regarded as good knowledge.

RESULTS:

Out of 141 respondents, 78 were females, 63 males, mean age of the participants was 38.17 ± 9.6 years, less than 40 years (n = 89), more than 40 years (n = 52). Nurses (n = 54), medical (n = 29), surgical (n = 35), primary health care (n = 23). Most of the study group with experience of fewer than 10 years (n = 66), 127 (90.1%) had good knowledge and 14 (9.9%) had poor knowledge p-value < 0.01.

CONCLUSION:

Our study revealed that Saudi health professionals have a good of knowledge about osteoporosis and no significant difference in osteoporosis knowledge between the health professional subgroups.

Validity, reliability, and responsiveness to change of the "Osteoporosis and You" knowledge scale

We studied the Osteoporosis and You knowledge scale in 7749 participants enrolled in a clinical trial. Results confirmed its psychometric properties in a diverse audience. Baseline scores were associated with better recall of bone mineral density test results at follow-up; however, the scale was not responsive to knowledge change.

INTRODUCTION

The goal of this study was to confirm the measurement properties of the Osteoporosis and You (O&Y) knowledge scale using classic test theory methods in the 7749 men and women participating in the Patient Activation After DXA Result Notification (PAADRN) randomized controlled trial. We hypothesized a simple factor structure that would reflect the four-factor model previously published.

METHODS

We conducted psychometric analyses which included item analysis, internal consistency reliability, construct validity using exploratory and confirmatory factor analysis (EFA and CFA), comparing knowledge levels across pre-specified groups, and responsiveness to change.

RESULTS

PAADRN participants were predominantly college educated, White females with low bone density, and a moderate level of 10-year fracture risk. EFA revealed four domains closely matching those in two previous reports. While overall scale reliability was minimally acceptable at 0.68, the reliabilities of the domain subscales were unacceptably low (0.59, 0.64, 0.45, and 0.36 for the Biological, Lifestyle, Consequences, and Prevention and Treatment subscales). CFA revealed the data fit the hypothesized model reasonably well with the items loading on their expected latent variable. The scale was not responsive to change, but although not significant, improved knowledge indicated better DXA result recall at 12 and 52 weeks.

CONCLUSIONS

In the PAADRN population, the O&Y knowledge scale had psychometric properties similar to those previously reported. Over 12 and 52 weeks, participants did not demonstrate significant changes in knowledge, but those with higher knowledge at baseline were more likely to accurately recall their baseline DXA result.

Osteoporosis Knowledge among Future Healthcare Practitioners: Findings from a Malaysian Public University

BACKGROUND AND OBJECTIVES

Students in relevant health-care academic programs are the future professionals who should play an active role in increasing community awareness regarding chronic diseases such as osteoporosis. This research aimed to evaluate the knowledge of osteoporosis, one of the growing health-care burdens in Malaysia, among students belong to three different health occupations programs in a Malaysian University.

METHODS

A cross-sectional study design was conducted to assess the level of knowledge on osteoporosis and to explore the potential association between the study program and osteoporosis-related knowledge among medicine, pharmacy, and allied health sciences students in a Malaysian University. A total of 348 students were approached. The data were collected using validated revised Osteoporosis Knowledge Test questionnaire.

RESULTS

The results showed variability in knowledge score between students belonging to different study programs. allied health sciences students have the highest overall total score (median = 20) and nutrition score (median = 16), but for exercise score, both students in allied health sciences and medicine programs shared a similar median score (median = 11.5). More than half of the respondents showed adequate knowledge on osteoporosis. The students from allied health sciences exhibited more knowledge on osteoporosis compared to students in other study programs. Among the Kulliyyah of Pharmacy respondents, the majority did not manage to answer correctly on the whole scale. This was evident by total percentage of 69.91% of the respondents scored below than median score.

CONCLUSION

There is a considerable gap of knowledge regarding osteoporosis among students in various health occupations academic programs. Pharmacy students particularly need focused learning related to exercise and nutrition in preventing osteoporosis during their academic program.

Exploring New Zealand orthopaedic nurses' knowledge of osteoporosis

BACKGROUND

Osteoporosis is a highly prevalent yet preventable disease. Nurses can play a major role in the prevention of osteoporosis and preventive treatment of patients who have had an osteoporotic fracture.

PURPOSE

This study explored whether New Zealand orthopaedic nurses have the knowledge to provide osteoporosis prevention education, and also examined these nurses' perceptions of their role in the diagnosis and prevention of osteoporosis.

METHODS

A questionnaire assessing osteoporosis knowledge was sent to a convenience sample of orthopaedic nurses. Data were analyzed quantitatively for the knowledge component, and qualitatively for the nurses' perception of their role, perceived barriers, and educational preferences.

RESULTS AND CONCLUSION

Findings reveal that New Zealand orthopaedic nurses have inadequate osteoporosis knowledge and this is a barrier to educating patients regarding osteoporosis. Adherence to published recommendations for the management of osteoporosis has been inconsistent. Confusion about who should lead osteoporosis prevention is evident and it seems that nurses play a passive role.

A model of health education and management for osteoporosis prevention

Osteoporosis, a chronic disease with no therapeutic cure, affects a growing number of people as the aging population in China rapidly increases. Therefore, developing an evidence-based model of health education and management for osteoporosis prevention is required. In the present study, an osteoporosis club was established, which is a novel model of health education and management for osteoporosis prevention. A unified management of membership was used based on a digitized database. A total of 436 patients with osteoporosis were randomly assigned to the osteoporosis club group or the self-management control group. For the osteoporosis club group, multiple activities of health education were performed, including monthly systematic health education lectures, exercise programs and communication parties once a year. For the control group, the participants took charge of their own musculoskeletal health. All data of the participants were collected and evaluated prior to and following intervention. In the pre-intervention assessment, no significant difference was identified in the health education between the two groups. Through the four-year intervention, the osteoporosis knowledge, health beliefs, living behavior, medication compliance, quality of life and bone mineral density of the osteoporosis club group were improved significantly compared with the control group (P<0.001), while the pain degree of the osteoporosis club group was relieved significantly more compared with the control group (P<0.001). The results in the present study suggest that setting up an osteoporosis club is an evidence-based model of health education and management for osteoporosis prevention in China.

Managing a Bone Healthy Lifestyle After Attending Multifaceted Group Education

We examined patients with osteoporosis implementation of recommendations regarding a bone healthy lifestyle after the patients attended multifaceted osteoporosis group education (GE). Our findings suggest that GE can support and influence patients' transfer of preventive actions. Still patients are challenged by concerns related to social roles and physical ability. We investigated if and how patients implemented knowledge from attending multifaceted osteoporosis GE in their daily lives. An interpretive description design using ethnographic field work was applied. In all 14 women and three men diagnosed with osteoporosis who attended multifaceted GE at a Danish hospital participated. Data consisted of field work and individual interviews in the participants' everyday environment after completion of GE. After attending multifaceted GE, participants experienced increased attention to and reflected more on how to implement osteoporosis preventive actions or activities. Participants who felt confident on how to act and experienced a clear need and motivation, or who could make the preventive activity into a social event, demonstrated an increased implementation of the preventive activity. On the contrary, attending GE was in some cases not sufficient to overcome social and physical concerns, or to eliminate uncertainty about recommendations or to make participants identify with the osteoporosis diagnosis, which thus impeded implementation of a bone healthy lifestyle. Attending multifaceted GE can support and influence participants' transfer of preventive actions into daily life. Being aware of how concerns about valued social roles and physical ability interfere with the implementation of medical recommendations obviously needs attention during GE.

Comparison of CAROC and FRAX in Fragility Fracture Patients: Agreement, Clinical Utility, and Implications for Clinical Practice

Objective.

To examine the level of agreement between 2 fracture risk assessment tools [Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX)] when applied within the context of the Canadian guidelines, in a population of fragility fracture patients.

Methods.

The sample consisted of 135 treatment-naive fragility fracture patients aged 50+ years and screened as part of an osteoporosis (OP) program at an urban hospital. Ten-year probabilities of future major osteoporotic fractures were calculated using the FRAX and CAROC. We also integrated additional qualifiers from the 2010 Canadian guidelines that place hip, spine, and multiple fractures at high risk regardless. A quadratic weighted κ (Kw) and 95% CI were calculated to estimate the chance corrected agreement between the risk assessment tools. Logistic regression was used to evaluate the factors associated with concordance.

Results.

Among patients with fragility fractures, the agreement between CAROC and FRAX was Kw = 0.64 (95% CI 0.58–0.71), with 45 of 135 cases in the cells reflecting disagreement. Younger persons and males were more likely to be found in discordant cells.

Conclusion.

The level of agreement between 2 commonly used fracture risk assessment tools was not as high in the patients with fragility fractures as it was in general community-based samples. Our results suggest discordance is found in less-typical patients with OP who need more consistency in messaging and direction. Users of these fracture risk tools should be aware of the potential for discordance and note differences in risk classifications that may affect treatment decisions.

Osteoporosis knowledge assessment and osteoporosis education recommendations in the health professions

A previous systematic review on osteoporosis knowledge published showed that only several studies investigated osteoporosis knowledge in health professionals, and it found that their knowledge was not as adequate and sufficient as it should be. Since then, studies published on osteoporosis knowledge among health professionals have also assessed and found that they still do not have adequate and sufficient osteoporosis knowledge. To increase and improve osteoporosis knowledge among health professionals, recommendations in osteoporosis education in the health professions, including the application of the cognitive load theory, online learning, problem-based learning, practical learning, simulation-based learning, interactive learning, and feedback are covered in order to ensure health professionals can have adequate and sufficient osteoporosis knowledge to best prevent and treat individuals with the disease.

Translating Osteoporosis Prevention Guidelines

OBJECTIVE

In Australia, the social gradient of chronic disease has never been as prominent as in current times, and the uptake of preventive health messages appears to be lower in discrete population groups. In efforts to re-frame health promotion from addressing behavior change to empowerment, we engaged community groups in disadvantaged neighborhoods to translate published preventive guidelines into easy-to-understand messages for the general population.

METHOD

Our research team established partnerships with older aged community groups located in disadvantaged neighborhoods, determined by cross-referencing addresses with the Australian Bureau of Statistics, to translate guidelines regarding osteoporosis prevention.

RESULTS

We developed an oversized jigsaw puzzle that we used to translate recommended osteoporosis prevention guidelines.

DISCUSSION

Successful participatory partnerships between researchers, health promotion professionals, and community groups in disadvantaged neighborhoods build capacity in researchers to undertake future participatory processes; they also make the best use of expert knowledge held by specific communities.

Imaging Internal Structure of Long Bones Using Wave Scattering Theory

An ultrasonic wavefield imaging method is developed to reconstruct the internal geometric properties of long bones using zero-offset data acquired axially on the bone surface. The imaging algorithm based on Born scattering theory is implemented with the conjugate gradient iterative method to reconstruct an optimal image. In the case of a multilayered velocity model, ray tracing through a smooth medium is used to calculate the traveled distance and traveling time. The method has been applied to simulated and real data. The results indicate that the interfaces of the top cortex are accurately imaged and correspond favorably to the original model. The reconstructed bottom cortex below the marrow is less accurate mainly because of the low signal-to-noise ratio. The current imaging method has successfully recovered the top cortical layer, providing a potential tool to investigate the internal structures of long bone cortex for osteoporosis assessment.

Osteoporosis-preventive behaviors and their promotion for young men

Osteoporosis in men is a major and neglected public health issue. An experimental study with a sample of 37 young men tested an osteoporosis prevention education intervention to alter osteoporosis health beliefs and to increase osteoporosis-preventive behaviors, in order to determine effectiveness and make public health recommendations. After pretest, control and treatment interventions were administered, with the administration of a posttest 2 weeks later. For all osteoporosis health beliefs and osteoporosis-preventive behaviors measured, no group and time interaction was found to be statistically significant. Both groups had low perceived susceptibility to osteoporosis, low to moderate perceived severity of osteoporosis, high perceived benefits of exercise and calcium to prevent osteoporosis, low perceived barriers to exercise and calcium, and moderate to high levels of confidence in self-efficacy for exercise and calcium. Bouts of exercise per week were adequate; however, consumption of good sources of calcium per day appeared to be low. More research is needed for the promotion of osteoporosis prevention in men. Recommendations promoting preventive behaviors for men have been provided.

Male and female differences in musculoskeletal disease

Gender differences exist in the presentation of musculoskeletal disease, and recognition of the differences between men and women's burden of disease and response to treatment is key in optimizing care of orthopaedic patients. The role of structural anatomy differences, hormones, and genetics are factors to consider in the analysis of differential injury and arthritic patterns between genders.

Knowledge change regarding osteoporosis prevention: translating recommended guidelines into user-friendly messages within a community forum

Background

Osteoporosis is a skeletal disorder characterised by low bone mineral density and increased fracture risk. Nationally the total costs of this chronic disease are currently estimated at $2.754 billion annually. Effective public health messages providing clear recommendations are vital in supporting prevention efforts. This research aimed to investigate knowledge change associated with the translation of preventive guidelines into accessible messages for the community.

Findings

We delivered a community-based information session that translated recommended guidelines for osteoporosis prevention into lay terms; items focused on dietary calcium, vitamin D, physical activity, alcohol, smoking and general osteoporosis-related knowledge. We developed a 10-item questionnaire reflecting these key points (score range 0–10) and investigated knowledge change associated with the session. Pre- and post-test questionnaires were completed by 47 participants (51% female), aged 21–94 years. Relatively high pre-test scores were observed for questions regarding sedentary activity and calcium intake. The lowest pre-test scores were observed for the item concerning whether swimming and cycling strengthened bones, and the highest possible score post-test was achieved for three of the items: calcium-rich food as a protective factor, and excessive alcohol and smoking as risk factors. The overall increase in knowledge change was a mean score of +2.08 (95%CI 1.58–2.42).

Conclusions

An increase in knowledge regarding osteoporosis prevention was demonstrated over the short-term. Our findings suggest that the guidelines concerning dietary calcium are generally well understood; however, the asymptomatic nature of osteoporosis and the types of physical activity that assist with bone strength are less well understood.

Osteoporosis knowledge, self-efficacy, and health beliefs among Chinese individuals with HIV

Individuals with HIV are at increased risk for osteoporosis and fracture. Using the Health Beliefs Model, we identified key relationships between knowledge, self-efficacy and health beliefs pertaining to physical activity and dietary calcium intake, two key modifiable preventive measures for osteoporosis.

PURPOSE

Individuals with HIV are at increased risk for osteoporosis and fracture. Few studies have systematically explored concerns related to osteoporosis prevention among this group. Applying the Health Beliefs Model (HBM), we examined associations between osteoporosis-related preventive health behaviors (i.e., physical exercise and dietary intake) and knowledge, self-efficacy and health beliefs in a large cohort of Chinese individuals with HIV.

METHODS

We conducted a cross-sectional study with participants from an ongoing multi-center trial. Volunteers completed a questionnaire consisting of the International Physical Activity Questionnaire (IPAQ), a calcium and vitamin D intake assessment, the Osteoporosis Knowledge Test, Osteoporosis Self-Efficacy Scale, Osteoporosis Health Beliefs Scale, and relevant sociodemographic and clinical risk factors.

RESULTS

A total of 263 of 297 eligible participants enrolled in this study. Mean age of participants was 38.4 ± 9.8 years, average BMI was 21.6 ± 2.6 kg/m(2), and 76 % were men. About 30 % of the sample reported low physical activity. Consumption of foods from each calcium and vitamin D-rich category averaged between multiple times per month to weekly. Knowledge regarding osteoporosis was universally low and self-efficacy correlated directly with engagement in preventive behaviors. Women and individuals with lower education perceived greater barriers to adopting preventive behaviors. Multivariate logistic regression adjusted for age, sex and BMI showed that calcium and vitamin D intake was directly correlated with knowledge and self-efficacy, whereas physical activity correlated with manual labor occupation, perceived barriers to exercise and health motivation.

CONCLUSIONS

Behavioral frameworks such as the HBM may provide important insight into promoting adoption and maintenance of osteoporosis-related preventive behaviors among individuals with HIV.

The impact of bone mineral density testing, fracture assessment, and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study

PURPOSE

Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated.

METHODS

A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar's test were used to assess changes in outcomes.

RESULTS

A total of 148 men completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < 0.0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = 0.015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = 0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ 0.001), and there was uptake of vitamin D supplementation from 44 % (n = 65) to 68 % (n = 99) (p < 0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. -0.22 ± 4.2, p = 0.005) compared to men with normal bone density.

CONCLUSIONS

Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.

Effectiveness and characteristics of multifaceted osteoporosis group education--a systematic review

The characteristics and effectiveness of osteoporosis multifaceted group education were determined from a systematic review of international literature. Findings showed that these educational programmes may be beneficial in a variety of important factors for the prevention, treatment and management of osteoporosis.

INTRODUCTION

This systematic review investigated quantitative studies on osteoporosis multifaceted group education. The purpose was to investigate the characteristics as well as the effectiveness of this form of osteoporosis patient education.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this systematic review. Relevant databases were searched until January 2013.

RESULTS

Seven studies published between 1993 and 2011 including osteoporosis patients with or without fractures were found. The multifaceted educational programmes all consisted of three overall themes: (1) Knowledge of osteoporosis, (2) Medication and diet and (3) Exercise, but with different foci across the studies. Overall, 24 outcome measures representing six topics were applied: (1) Health-related quality of life, (2) Psychosocial function, (3) Pain, (4) Physical activity, (5) Knowledge and (6) Medication and diet. The review showed that multifaceted osteoporosis group education can increase the patients' knowledge of osteoporosis as well as their health-related quality of life, physical activity and psychosocial functioning. It has the potential to increase adherence to both pharmacological and non-pharmacological treatments.

CONCLUSIONS

Multifaceted group education may have a positive impact on the patients' ability to engage in preventing and managing osteoporosis. Further research directed towards the complexity of multifaceted group education is needed. In addition, research investigating the educational needs of specific groups of osteoporotic patients is required.

Analysis of ultrasonic waves propagating in a bone plate over a water half-space with and without overlying soft tissue

Recent in vitro studies have shown that guided waves can characterize bone properties. However, for clinical applications to be viable, the soft-tissue layer should be considered. This study examined the effect of soft tissue on guided waves using a bovine bone plate over a water half-space and overlaid by a 4-mm gelatin-based soft-tissue mimic. The data (with and without soft tissue) clearly show a high-frequency, fast-propagating wave packet and a low-frequency, delayed phase group. The presence of soft tissue attenuates the signals significantly and increases mode density and number as predicted by theory. The data retain higher frequency content than the bone-plate data at large offsets. Using theoretical dispersion curves, the guided modes can be identified with mode 1 (similar to the A0 Lamb mode) minimally affected by the addition of soft tissue. There is infiltration of high-frequency, late-arriving energy within the low-velocity guided-wave regime. Results of travel-time calculation suggest that P-wave and PP-reflections/multiples within the soft tissue may be responsible for the high-frequency oscillations.

Knowledge and health literacy are not associated with osteoporotic medication adherence, however income is, in Arab postmenopausal women

OBJECTIVE

To investigate the association between adherence with oral bisphosphonate treatment, income, health literacy, knowledge, and receiving instructions from a pharmacist or doctor, among Arab postmenopausal women diagnosed with osteoporosis in Israel.

METHODS

Arab osteoporotic women treated with oral bisphosphonates were interviewed (303 women). The questionnaire included socio-demographic characteristics, knowledge about osteoporosis and health literacy. Adherence was measured by the Medication Possession Ratio (MPR) according to the number of prescription refills registered in the database of Clalit Health Services.

RESULTS

Forty-one percent of the women were adherent according to the MPR. The main predictor of adherence in a multivariate logistic regression was income. Health literacy and knowledge were not associated with adherence after adjustment for income. Neither was the health care provider's counseling regarding the medication.

CONCLUSIONS

Lower income seems to be a barrier to adherence with osteoporotic medication, over and above other known barriers. Policy makers should take into account that medication funding may be a barrier to treatment. Practical implications Income may be a major barrier to adherance with osteoporosis medication and calls for attention of practiciner.

Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus

SUMMARY

This study was conducted to determine the level of osteoporosis knowledge and beliefs among nursing college students in Damascus. A worrying deficit of knowledge was found. They believed osteoporosis to be a serious disease but did not feel susceptible to or concerned about it. Innovative educational interventions should be considered.

PURPOSE

Increasing awareness, knowledge, and promoting healthy behaviors about osteoporosis and related risk factors are effective prevention measures for building and maintaining strong bone throughout the life-span. We hypothesized a lack of knowledge and unhealthy beliefs about osteoporosis among young women in our setting. The level of osteoporosis knowledge, beliefs, and behavior among nursing college students in Damascus was evaluated in this study.

METHODS

A cross-sectional study was conducted on a convenience sample of female young students seen at the nursing school. All students registered for the year 2011-2012 were included in the study. A self-administered questionnaire was implemented. The questionnaire included background information and both osteoporosis-related tools (Arabic version), namely the Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale.

RESULTS

A total of 353 female students answered the questionnaire with a response rate of 98.3%. A worrying deficit of knowledge was found among surveyed Syrian young adult females with a total mean score of 7.9 (2.7) out of possible 20 points, being 39.6% of possible maximum score on the OKAT. Those young women believed osteoporosis to be a serious disease but did not feel susceptible to or concerned about the illness. Perceived moderate to high barriers to exercises and calcium intake indicated negative health beliefs.

CONCLUSIONS

The findings generally reveal poor knowledge about osteoporosis among nursing school female students at Damascus. Integration of osteoporosis in school curricula and public education efforts is urgently needed.