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

Assessment of osteoporosis awareness and knowledge levels in people living with HIV

OBJECTIVE

Human immunodeficiency virus is associated with an increased risk of osteopenia and osteoporosis through multiple complex mechanisms. With an increased awareness on this issue, patients can avoid the preventable causes of osteoporosis. The aim of this study was to assess the awareness and knowledge regarding osteoporosis among people living with HIV (PLWH).

METHODS

A total of 329 PLWH agreed to participate in the study. The patients completed a Google Forms questionnaire consisting of three sections. The first section included binary (yes/no) questions to assess participants' awareness of osteoporosis, knowledge about the condition, perceived susceptibility, and understanding of potential complications. The second section employed the Osteoporosis Awareness Scale, while the third section employed the Revised Osteoporosis Knowledge Tool.

RESULTS

The average age of the 329 patients was 40.21±12.4 years, and 89.4% were male. The mean scores were 66.97±20.68 on the Osteoporosis Awareness Scale and 16.34±6.37 on the Revised Osteoporosis Knowledge Tool. When asked whether they were familiar with osteoporosis, 53.2% of the participants responded yes. Notably, 40% of the participants had knowledge about osteoporosis and its complications, with 50.8% believing that osteoporosis is a serious condition that can be life-threatening. Osteoporosis awareness increased proportionally with the level of education (p<0.001). Patients with a pre-treatment CD4 count<200/mm³ had significantly lower levels of both osteoporosis awareness and knowledge (p<0.001).

CONCLUSION

This study revealed that PLWH have insufficient knowledge and low awareness regarding osteoporosis. In particular, patients with a pre-treatment CD4 count<200/mm³ and those with lower education levels were found to have the lowest awareness level of osteoporosis.

Effect of a Supervised Exercise Program on Exercise Self-Efficacy in Aging Adults With and Without HIV: A Secondary Analysis of the Exercise for Healthy Aging Study

With earlier initiation and more effective antiretroviral therapy regimens, people with HIV (PWH) are achieving longer lifespans but with high rates of chronic disease and physical function impairment. Regular exercise can reduce disease burden, but older adults with HIV may experience unique barriers to exercise. Exercise self-efficacy (ESE) is an important component of initiation and continuation of exercise, and ESE measurement may illuminate barriers to exercise. Our goal was to evaluate differences in ESE between older PWH and seronegative participants (controls) prior to exercise initiation and over 24-weeks of a supervised resistance and endurance exercise intervention. Virally suppressed PWH and controls completed 12 weeks of moderate-intensity exercise, followed by randomization to 12 weeks of moderate- or high-intensity exercise. The Self-Efficacy for Exercise survey was completed at weeks 0, 12, and 24. Enrolled participants (PWH = 32, controls = 37) had a median age of 56 years [interquartile range: 52, 62]; 63 (91%) were male, and 23 (33%) identified as ethnic or racial minorities. ESE scores differed by serostatus prior to exercise initiation (PWH: 61.3 [95% confidence interval: 54.5, 68]; controls: 73.8 [67.6, 80.1]; p = 0.01; t = - 2.7). ESE scores did not change over the initial 12 weeks in PWH (4.8 [- 2.1, 11.8]; p = 0.17; t = 1.4) or controls (- 2.3 [- 8.9, 4.4]; p = 0.50; t = - 0.7) or between weeks 13 and 24 (pooled serostatus: - 4.8 [- 9.7, 0.2]; p = 0.06: t = - 1.9). Future interventions should incorporate additional strategies to improve ESE, such as text messaging support, coaching, or external rewards.

Knowledge, Attitudes, and Practices of Patients with Knee Osteoarthritis Regarding Osteoporosis and Its Prevention: A Cross-Sectional Study in China

Background

Older age and female sex are risk factors for osteoarthritis and osteoporosis (OP). This study evaluated the knowledge, attitudes, and practices of patients with knee osteoarthritis (KOA) in China regarding OP and its prevention. This cross-sectional, questionnaire-based study enrolled patients with KOA at four grade-A tertiary hospitals in Shandong Province between 1st September and 20th November 2022.

Methods

The administered questionnaire contained 55 items across four dimensions (demographic information, knowledge, attitude, and practice). Logistic regression analyses were performed to identify factors associated with an overall questionnaire score ≥70% of the maximum possible score. SPSS 26.0 was used for the analyses; P<0.05 was considered significant.

Results

The analysis included 434 participants (261 females). The median knowledge, attitude, and practice scores were 7 (interquartile range: 5-10) (possible range, 0-17 points), 44 (interquartile range: 42-49) (possible range, 11-55 points), and 43 (interquartile range: 38-47) (possible range, 13-65 points), respectively. Multivariable logistic regression indicated that female sex (odds ratio [OR], 2.421; 95% confidence interval [95% CI] 1.558-3.762; P<0.001), age 56-65 years-old (OR, 4.222; 95% CI, 1.763-10.109; P=0.001 vs ≤55 years-old), age >65 years-old (OR, 4.358; 95% CI, 1.863-10.195; P=0.001 vs ≤55 years-old), middle/high/technical secondary school education (OR, 1.853; 95% CI, 1.002-3.428; P=0.049 vs primary school or below), and having KOA for 4-5 years (OR, 2.682; 95% CI, 1.412-5.094; P=0.003 vs ≤3 years) were independently associated with a high KAP score.

Conclusion

There is room for improvement in the knowledge and practices of patients with osteoarthritis in China regarding OP. The findings of this study may facilitate the design and implementation of education programs to increase awareness about OP prevention among patients with KOA.

Knowledge, Awareness and Perception towards Osteoporosis Risk in China: A Systematic Review

Background

We aimed to evaluate the level of knowledge, awareness, and perceptions regarding osteoporosis (OP) and risk factors in China.

Methods

The databases of PubMed, Medline, Embase, Web of science, VIP, and CNKI were searched for papers published before December 2022 using Chinese and English keywords and their combinations: "knowledge", "osteoporosis", "risk factor", "bone health", "perception", "awareness". The levels of knowledge, awareness, and perception about OP, as well as risk factors, clinical symptoms, and health information sources were narratively synthesized.

Results

Sixteen papers were finally included for analysis. Participants all showed poor levels of knowledge and perception regarding osteoporosis and risk factors. Investigation of clinical symptoms was rarely involved in the included studies due to the asymptomatic features of OP. The findings also suggest a strong association between poor level of knowledge regarding OP and educational attainment, type of participant, and gender. The majority of participants are increasingly turning to the Internet and social media to access information about OP.

Conclusion

The findings of this paper provide useful information for intervention providers to prevent and control OP and encourage them to carry out health promotion campaigns to enhance knowledge and awareness of OP.

Assessment of osteoporosis knowledge and its determinants among tuberculosis patients in tertiary care hospital Malaysia: A prospective study

Objective

Osteoporosis self-care knowledge is essential to encourage the patient's contribution towards controlling the disease. Osteoporosis incidence with various infectious diseases prompts us to conduct a study on osteoporosis knowledge among Tuberculosis (TB) patients. This study aimed to assess osteoporosis-related knowledge and its influencing factors among TB patients.

Methods

A prospective cross-sectional study was conducted in the TB clinic of Hospital Pulau Pinang, Malaysia, and an osteoporosis knowledge test (OKT), a structured questionnaire, was used to collect data. TB patients aged 18 years and above with compromised bone health were included in the present study. Overall knowledge scores were dichotomized, calculating the mean score, descriptive statistics, and multivariate regression analysis was used to determine the influence of risk factors on knowledge scores.

Results

Of 337 patients, 129(38.28 %) had good osteoporosis knowledge and 208(61.72 %) had poor knowledge. Among them, 231(68.54 %) were males, and 106(31.45 %) were females, with a mean age of 46.5 ± 17.1 years. The mean ± SD of OKT total score was 10.5 ± 2.0. The mean ± SD of the exercise knowledge score was 5.3 ± 3.4, while the nutrition knowledge score was 5.0 ± 3.2. Male gender (OR 3.86, 95 % CI 1.98-7.53), low-income level (OR 1.92, 95 % CI 1.12-3.30), rural residents (OR 2.49, 95 % CI 1.46-4.27) and participants with no formal education (OR 4.34, 95 % CI 1.11-16.84) or ≤12 years of education (OR 3.63, 95 % CI 1.52-8.65) were significantly responsible for poor OKT score.

Conclusion

The results indicated that most TB patients had a poor perception of osteoporosis. More extensive strategies should be developed to enhance the campaign of awareness programs among TB patients to improve preventive measures of osteoporosis, such as calcium intake and exercise.

Predicting osteoporosis preventive behaviors in middle-aged and older urban Shanghai residents: a health belief model-based path analysis in a multi-center population study

Background

Osteoporosis represents a significant health concern as a widespread metabolic bone condition. In this study, we aim to utilize path analysis to examine the intricate relationships among demographic information, Health Belief Model (HBM) constructs and osteoporosis preventive behavior among Shanghai residents over 40 years of age.

Methods

A multi-center population study was conducted in 20 volunteer communities in Shanghai, China. Out of the 2,000 participants who volunteered, 1,903 completed the field survey.

Results

56.0% of participants were females. Their mean age was 63.64 ± 10.30 years. The self-efficacy score among females (42.27 ± 15.82) was also significantly higher than that among males (40.68 ± 15.20). in the pathway analysis. In the path analysis preventive behaviors were significantly predicted by education (β = 0.082, p < 0.001), knowledge (β = 0.132, p < 0.001) and self-efficacy (β = 0.392, p < 0.001).

Conclusions

This study highlights the importance of gender, education, knowledge and self-efficacy in promoting OP preventive behaviors using the Health Belief Model. The findings emphasize the need for tailored interventions to address the specific needs of different demographic groups.

Prevalence of and risk factors for vertebral fracture and low bone mineral density among Peruvian women aging with HIV

Osteoporosis and fracture risk among women with HIV in Latin America is understudied. In a sample of Peruvian women with and without HIV, women with HIV had lower femoral neck and total hip BMD and a higher proportion of vertebral fractures. Important treatment gaps were identified across both groups.

PURPOSE

Studies have shown that patients with HIV are at increased risk for bone loss and fracture due to a combination of host, viral, and antiretroviral therapy (ART)-related factors. We aimed to explore the prevalence of vertebral fracture (VF) and low bone mineral density (BMD) among women aging with HIV in Peru and identify risk factors for osteoporosis and fracture in this population.

METHODS

We enrolled women living with and without HIV aged ≥40 years between 2019 and 2020. Participants completed a survey and obtained dual X-ray absorptiometry (DXA) test to assess BMD at the lumbar spine (LS), femoral neck (FN), and total hip (TH). A subset of patients also obtained lateral thoracolumbar X-rays. Presence of VF was determined using the Genant semiquantitative method. Regression analyses were used to model associations between key risk factors and BMD.

RESULTS

104 women living with HIV and 212 women living without HIV were enrolled with a mean age of 52.4±8.2 and 56.4±8.8 years (p < 0.001). Among postmenopausal women (257/316, 81.3%), 26.3% of women living with HIV and 25.9% of those without HIV had osteoporosis. Among the 88 women living with HIV and 178 women living without HIV who obtained thoracolumbar X-rays, 12.5% and 6.2%, respectively, had at least one VF. Based on DXA and the FRAX score, 22/104 women living with HIV met criteria for osteoporosis treatment according to national guidelines; however, none were on treatment. Propensity score matching revealed that women living with HIV had 0.032 g/cm2 lower FN BMD (p = 0.012) and 0.034 g/cm2 lower TH BMD (p = 0.041) compared to women without HIV.

CONCLUSION

In this study, women living with HIV on long-standing ART had increased VF prevalence compared to the slightly older group of women without HIV. Age and BMI were independent predictors for BMD at the lumbar spine, hip, and femoral neck among women living with HIV, and there was a treatment gap among women who met criteria for osteoporosis treatment. Larger studies are needed in this region to identify individuals at risk for fracture and to inform prevention guidelines.

The Role of the Social Determinants of Health on Engagement in Physical Activity or Exercise among Adults Living with HIV: A Scoping Review

Physical activity (PA) and exercise are an effective rehabilitation strategy to improve health outcomes among people living with HIV (PLWH). However, engagement in exercise among PLWH can vary. Our aim was to characterize the literature on the role of social determinants of health (SDOH) on engagement in PA or exercise among adults living with HIV. We conducted a scoping review using the Arksey and O'Malley Framework. We searched databases between 1996 and 2021. We included articles that examined PA or exercise among adults with HIV and addressed at least one SDOH from the Public Health Agency of Canada Framework. We extracted data from included articles onto a data extraction charting form, and collated results using content analytical techniques. Of the 11,060 citations, we included 41 articles, with 35 studies involving primary data collection 23 (66%) quantitative, 8 (23%) qualitative, and four (11%) mixed methods. Of the 14,835 participants, 6398 (43%) were women. Gender (n = 24 articles), social support (n = 15), and income and social status (n = 14) were the most commonly reported SDOH in the literature with the majority of studies addressing only one SDOH. Future research should consider the intersection between multiple SDOH to better understand their combined impact on engagement in PA or exercise among PLWH.

The effect of educational intervention based on theory of planned behavior on behavioral responses of premenopausal women in prevention of osteoporosis

BACKGROUND

Osteoporosis is one of the most prevalent bone diseases which is preventable. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. One of the theories used for predicting behavior and performing educational intervention is theory of planned behavior (TPB) which predicts the intention of an individual toward doing a specific behavior. This study was conducted to assess the effect of educational intervention based on TPB on behavioral responses of premenopausal women in prevention from osteoporosis in Fasa city, Iran.

METHODS

This study is a quasi-experimental study performed on 200 women aging from 35 and 55 years who referred to health centers in Fasa city; iran in 2019. Simple random sampling was applied to assign participants to control and intervention groups (100 participant for each group). Data were gathered by a "valid" and "reliable" questionnaire arranged based on the constructs of TPB, nutrition performance and physical activity. An educational program on osteoporosis prevention was conducted. educational intervention was performed in six sessions through group discussions and educational films and booklet for experimental group and then the changes in the scores of the two groups were evaluated and compared. Obtained data were analyzed by SPSS-22 software through Chi-square, independent t-test, paired t-test and ANOVA tests.

RESULTS

The mean ages of studied participants in experimental and control groups were respectively 43.39 [Formula: see text] 5.20 and 42.94 [Formula: see text] 5.52. In experimental group, the average scores of knowledge [2 weeks (31.12 [Formula: see text] 4.20) and 2 months (39.04 [Formula: see text] 4.10) after educational intervention (p < 0.001)], constructs of theory of planned behavior [attitude construct: 2 weeks (89.32 [Formula: see text] 9.22) and 2 months (98.57 [Formula: see text] 9.13) after educational intervention (p < 0.001), Subjective norms construct: 2 weeks(88.39 [Formula: see text] 8.84) and 2 months (122.57 [Formula: see text] 8.58) after educational intervention (p < 0.001), Perceived behavioral control construct: 2 weeks (88.56 [Formula: see text] 8.38) and 2 months (120.15 [Formula: see text] 8.33) after educational intervention (p < 0.001), Behavioral intention construct: 2 weeks (54.44 ± 4.72) and 2 months (60.26 [Formula: see text] 4.12) after educational intervention (p < 0.001)], nutrition performance [2 weeks (19.88 ± 2.56) and 2 months (24.14 [Formula: see text] 2.36) after educational intervention (p < 0.001)] and physical activity [2 weeks (16.75 [Formula: see text] 1.42) and 2 months (18.94 [Formula: see text] 1.68) after educational intervention (p < 0.001)] had more significant enhancement than control group 2 weeks and 2 months after educational intervention.

DISCUSSION

TPB was effected in nutrition performance and physical activity in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational intervention for preventing osteoporosis and promoting women's health.

Physical Activities and Associated Factors Among HIV/AIDS Patients: A Questionnaire Survey

Purpose

Regular physical activity is essential for maintaining health and improving people's overall quality of life living with HIV; improving metabolic side effects associated with taking highly active antiretroviral therapy (HAART). This study investigated physical activity levels and associated factors among HIV/AIDS patients.

Patients and Methods

A single-center, cross-sectional study was conducted from July to September 2021. A convenience sample of 377 HIV/AIDS patients was recruited from a medical center in Zhuhai, China. Data were collected through self-report questionnaires and patients' medical records.

Results

The average physical activity of HIV/AIDS patients was 1007.15±868.63 met-min/w; 53.8% of patients expressed medium-level activity, and 46.2% in low-level activity. Log-link gamma generalized linear model results showed that gender, T-CD4+ at the latest visit, self-efficacy, and perceived barriers were significant predictors of assessing physical activity levels.

Conclusion

Nearly half of HIV/AIDS patients have low levels of physical activity. In particular, women and patients with lower CD4 cells, lower self-efficacy, and more perceived barriers had lower levels of physical activity. More knowledge is needed on the causes of physical inactivity among people with HIV, and physical activity programs need to be developed for people living with HIV in developing countries.

Health-related quality of life among women aging with and without HIV in Peru

Background

Studies have shown that women aging with HIV have significantly lower health-related quality of life (HRQoL) compared to women without HIV. However, no studies have examined this issue in Latin America and the Caribbean. We aimed to explore HRQoL measured by the 36-Item Short Form Health Survey (SF-36) among women aging with and without HIV in Peru.

Materials and methods

We conducted a cross-sectional study at a large HIV-clinic in Peru. Outcomes of the SF-36 were evaluated, exploring the relationship between physical activity (International Physical Activity Questionnaire), sociodemographic factors (ethnicity, alcohol/tobacco use, age, BMI) and clinical data (AIDS progression, treatment duration, CD4+ cell count and viral load, years since HIV diagnosis) with HRQoL using regression analysis. Statistical significance was set with a two-tailed p-value <0.05.

Results

We enrolled 427 women (175 HIV-infected) with mean age of 54±8 years. From the SF-36 individual domains: physical functioning, role limitations due to physical and emotional health, and emotional wellbeing were significantly lower for HIV-infected women. Summary component scores were lower for the HIV-subset for both physical (45.8 vs 47.3) and mental (45.1 vs 45.8) components, although they did not achieve statistical significance. Regression analysis of the HIV-infected women revealed that the physical component score was significantly associated with physical activity, ethnicity, and chronic comorbidities while the mental component was significantly associated with physical activity, employment, and CD4+ cell count.

Conclusion

In our study, HIV-infected women scored lower in both physical and mental component scores. Important determinants for each component included CD4+ cell count as an assessment of HIV severity for the mental component, and ethnicity, reflecting socio-cultural factors, for the physical component. These results reveal the importance of a holistic approach to addressing HRQoL in this population. Better understanding of these factors will help shape future policies and interventions to improve HRQoL of women aging with HIV.

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.

Parental Adherence to Ideal Cardiovascular Health Status Was Associated With a Substantially Lower Prevalence of Overweight and Obesity in Their Offspring Aged 6-18 Years

Background: Parental health status had a potential influence on offspring health. This study aimed to investigate the separate associations between paternal and maternal cardiovascular health statuses and the prevalence of childhood overweight and obesity in the offspring. Methods: Data were from a cross-sectional study conducted in seven provinces or cities of China in 2013. A total of 29,317 children aged 6-18 years old and their parents, making up 9,585 father-offspring pairs and 19,732 mother-offspring pairs, were included in the final analysis. Information on parental cardiovascular health status factors (dietary behaviors, body mass index (BMI), smoking, physical activity, hypertension, and diabetes mellitus) was obtained from the structured self-administrated questionnaires. Based on the health status factors, we then generated an ideal cardiovascular health (iCVH) score. The overweight and obesity of children were defined using age- and sex-specific cutoffs based on the International Obesity Task Force criteria. A multilevel log-binomial regression model was used to assess the association between parental cardiovascular health status and prevalence of childhood overweight and obesity in the offspring. Results: The prevalence of pediatric overweight and obesity was 22.0% in the father-offspring subset and 23.8% in the mother-offspring subset, respectively. Fathers with ideal BMI, non-smoking, and absence of hypertension and diabetes, and mothers with ideal BMI, ideal physical activity, and absence of hypertension and diabetes were found to be associated with lower prevalence of overweight and obesity in the offspring. The prevalence of offspring overweight and obesity was significantly decreased with the parental iCVH scores increased. Each additional increase in paternal and maternal iCVH factor was associated with a 30% and 27% lower prevalence of overweight and obesity in the offspring. Compared with children whose parental iCVH scores ≤ 3, offspring whose fathers or mothers met all six iCVH factors had 67% [prevalence ratio (PR): 0.33, 95%CI: 0.25-0.42] and 58% (PR: 0.42, 95%CI: 0.29-0.62) lower prevalence of overweight and obesity, respectively. Conclusions: Parental adherence to iCVH status was associated with a lower prevalence of pediatric overweight and obesity in offspring. Our findings support the intervention strategy that parents should involve in the obesity intervention program for children.

Validation of a six-item dietary calcium screening tool among HIV patients in China

OBJECTIVE

Individuals with HIV are at increased risk for osteoporosis. A healthy diet with adequate Ca is recommended to promote bone health. However, lengthy nutritional assessments pose barriers to routine screenings in clinical practice. This study aimed to examine the validity and reproducibility of a six-item dietary Ca screening tool among Chinese individuals with HIV.

DESIGN

We conducted a two time-point study in an outpatient setting. Volunteers self-administered the six-item tool upon enrolment and again at 1-month follow-up. At baseline, participants also completed a validated FFQ and surveys regarding demographic and clinical risk factors.

SETTING

Beijing, China; Shenzhen, Guangdong, China.

PARTICIPANTS

Upon enrolment, 127 individuals with HIV participated in the study, of whom 83 completed the follow-up screening.

RESULTS

Mean age of participants was 35·2 (sd 9·3) years, average BMI was 22·8 (sd 3·8) kg/m2 and 89 % were men. Among the participants, 54·7 % reported Ca intake less than 800 mg/d. The six-item tool demonstrated fair-to-moderate relative validity with a correlation of 0·39 and 75·7 % of subjects classified in same/adjacent quartiles as the reference, and moderate-to-good reproducibility with a correlation of 0·60 and 83·1 % of subjects classified in same/adjacent quartiles. Finally, receiver operating characteristic analyses yielded a sensitivity of 87·0 % and a specificity of 39·4 % with optimised cut-off level.

CONCLUSIONS

The six-item tool presented adequate validity and reproducibility to identify individuals with low Ca intake among the target population, providing a convenient instrument for categorising Ca intake in clinical practice, prompting referrals for further assessment, and raising awareness of dietary Ca in bone disease prevention.

Long-term trabecular bone score and bone mineral density changes in Chinese antiretroviral-treated HIV-infected individuals

This is the first 5-year analysis among persons with HIV (PWH) that reports both trabecular bone score (TBS), which is a novel index that estimates bone microarchitecture, and bone mineral density (BMD) over time to evaluate the long-term impact of antiretroviral therapy (ART) on bone health.

PURPOSE

HIV infection and antiretroviral therapy (ART) have been associated with decreased bone mineral density (BMD). This study aims to evaluate long-term changes in trabecular bone score (TBS), a novel index that estimates bone microarchitecture, and BMD among Chinese persons with HIV (PWH) treated with ART.

METHODS

We conducted a retrospective chart review of adult PWH at a large tertiary care hospital in China. Patients who had a DXA scan prior to ART and at least one follow-up DXA after ART initiation were included. Subgroup analyses examined the TBS and BMD changes in patients who switch from a non-TDF-containing regimen to one containing TDF, as compared to those who did not switch.

RESULTS

Four hundred fifty-nine PWH were included. Among 68 patients ≥ 50 years, 13 patients (19.1%) had a normal BMD but partially degraded or degraded TBS. The mean percent decrease in lumbar spine (LS) BMD nadired at 48 weeks after ART initiation and then gradually improved. Percent decrease in femoral neck (FN) and total hip (TH) BMD nadired at 96 weeks and remained stably low thereafter. After switch to a TDF-containing regimen, only percent change in TH BMD was significant (-3.2%, p = 0.006). In the regression analyses, switch to a TDF-containing regimen was not associated with long-term change in TBS or BMD.

CONCLUSION

This is the first study among PWH to evaluate the long-term impact of ART on TBS and BMD. At baseline, approximately 20% of patients had a normal BMD but impaired bone microstructure based upon TBS. For patients with 5 years of exposure to ART, there is a stabilization of TBS and BMD after initial nadir in the first 144 weeks. However, FN BMD, TH BMD, and TBS remained low at 5 years relative to baseline.

Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy

This is the first study to report changes in BMD and related risk factors among Chinese patients with HIV after initiation of tenofovir disoproxil fumarate (TDF)-containing antiretroviral therapy. Greater bone mineral density (BMD) loss was observed in patients treated with TDF, compared to those on non-TDF-containing regimens. Our findings provide important knowledge regarding the risk factors in the long-term clinical management of patients with HIV in China.

INTRODUCTION

Persons living with HIV (PLWH) are at increased risk for osteoporosis and fracture. Tenofovir disoproxil fumarate (TDF) has been associated with higher rates of bone mineral density (BMD) loss, osteoporosis, and fracture. Few studies have studied the impact among PLWH in Asia.

METHODS

We analyzed retrospectively patients from the outpatient HIV clinic of a large tertiary hospital in Beijing, China, from March 2007 to May 2016. Patients who had dual-energy X-ray absorptiometry testing prior to antiretroviral initiation and at 48 and/or 96 weeks after initiation were included in this analysis.

RESULTS

A total of 136 patients were included (mean age 36.0 ± 10.6 years) and over 90% participants were male and Han Chinese ethnicity. We observed greater declines in BMD at the spine from baseline to week 48 (-2.94% vs. -0.74%) and at the hip from baseline to week 96 (-4.37% vs. -2.34%) in the TDF group compared with the non-TDF group. With regard to HIV-specific parameters, longer duration since HIV diagnosis and undetectable viral load over time were associated with lower BMD at the hip [relative risk (RR) 0.97, 95% confidence index (CI) (0.95, 0.99) per 1 year increase and RR 0.96, 95%CI (0.94, 0.99), respectively] and femoral neck [RR 0.97, 95%CI (0.95, 0.99) per 1 year increase and RR 0.97, 95%CI (0.95, 0.998), respectively] over 96 weeks.

CONCLUSIONS

This is the first study to report changes in BMD among PLWH after initiation of TDF-based antiretroviral therapy in China. Our findings provide important knowledge for the long-term clinical management of PLWH from this region.

Osteoporosis health beliefs and self-efficacy among orthopedic nurses in Hunan Province, China

Osteoporosis is a growing health problem worldwide. Health beliefs and self-efficacy in regard to osteoporosis may be important targets in preventive behaviours. This study aimed to describe beliefs around osteoporosis held by orthopaedic nurses as well as the nurses' self-efficacy and the associations between knowledge, health beliefs and self-efficacy. A cross-sectional study was conducted with nurses working in orthopaedic departments in 13 tertiary hospitals in Hunan Province, China. Participants completed a questionnaire consisting of the Osteoporosis Health Belief Scale (OHBS), the Osteoporosis Self-Efficacy Scale (OSES) and a survey of their socio-demographic characteristics. A total of 558 nurses completed the survey (response rate 95%). The nurses' scores regarding their perception of the susceptibility to and seriousness of osteoporosis were moderately low (mean OHBS score = 124.72, range 45-171; SD = 14.71), while their corresponding self-efficacy scores were moderately high (mean OSES score = 72.01, range 0-120; SD = 23.15). Knowledge regarding osteoporosis was positively associated with self-efficacy (r = 0.232, p = 0.000) but not with health beliefs (r = 0.030, p = 0.484). The findings of this study revealed moderately high self-efficacy and moderate health beliefs related to osteoporosis among orthopaedic nurses. Osteoporosis knowledge was not associated with health beliefs or self-efficacy. The findings indicate that educational programs should not only focus on knowledge improvement but also changes in health beliefs to improve actual behaviour in practice.

Understanding Patients' Perspectives and Educational Needs by Type of Osteoporosis in Men and Women and People with Glucocorticosteroid-Induced Osteoporosis: A Qualitative Study to Improve Disease Management

The aim of the study was to investigate similarities and differences in health beliefs, experiences and educational needs by type of osteoporosis (OP), particularly in people with glucocorticoid-induced OP (GIOP) and men. A qualitative study was conducted via focus groups involving post-menopausal women with or without osteoporotic fractures, osteoporotic men and people with GIOP. Fifty-three participants were included in eight groups. A wide range of health beliefs was found for all types of OP. Osteoporosis was considered a natural consequence of ageing except in men or conversely a serious disease associated with risk of new fractures and disability. GIOP patients had heterogeneous knowledge of OP and reported fewer prevention behaviours, and their quality of life was affected by the causal illness. Men had difficulties coping with the loss of their functional abilities and felt that OP was a "women's" disease. Beliefs about treatments ranged from confidence to fear of adverse effects or doubt about efficacy in all types of OP. Participants were interested in physical activity, fall prevention and diet, and preferred group sessions. GIOP patients and men had an interest in face-to-face education. Men were also interested in brief information including via the Internet. Patients' beliefs about OP differed by type of OP. Specific populations such as men or people with GIOP need particular care owing to experiences and needs. Offering group sessions in educational interventions is of interest to allow for sharing experiences and also face-to-face education for men and GIOP patients or the Internet for men.

The Application of PRECEDE Model on Preventing Osteoporosis in Women

The aim of this study is investigating the efficiency of educational intervention based on PRECEDE model on promotion of osteoporosis prevention behaviors in women. This quasi-experimental study was conducted on 200 women registered in two health centers of Fasa city, Fars province, Iran in 2017 to 2018. A questionnaire including items evaluating demographic information and PRECEDE model constructs was used for measuring nutrition and walking performance of studied women in osteoporosis prevention before and 12 months after intervention. Bone mineral density (BMD) was recorded at the lumbar spine and femur before and 12 months after intervention. One year after intervention, the intervention group showed a significant increase in knowledge, attitude, self-efficacy, reinforcing factors, enabling factors, nutrition, and walking performance compared to the control group. Also, the value of lumbar spine and hip BMD T-Score of the intervention group was increased, while this value was reduced in the control group. Our findings showed that educational interventions based on PRECEDE model can positively affect prevention behaviors from osteoporosis by improving subjects' knowledge, attitude, enabling factors (resources such as health care access and services that can provide motivation for prevention behaviors from osteoporosis in women), self-efficacy, and reinforcing factors.

Osteoporosis knowledge and beliefs in diabetic patients: a cross sectional study from Palestine

BACKGROUND

Osteoporosis is a potential metabolic complication of diabetes mellitus (DM). Therefore, patients with DM should have adequate osteoporosis knowledge and beliefs in order to get engaged in osteoporosis preventive behaviors. The objective of this study was to assess osteoporosis knowledge and beliefs among diabetic patients.

METHODS

This was a cross sectional study carried out at Al-Makhfiah governmental primary healthcare unit in Nablus, Palestine from September 2016 to December 2016. The tools used to assess knowledge and beliefs were Osteoporosis Health Belief Scale (OHBS) and the Osteoporosis Knowledge Test (OKT) respectively.

RESULTS

Three hundred diabetic patients were interviewed regarding their knowledge and belief about osteoporosis. The study sample included 192 (64.0%) females. Mean ± standard deviation (SD) of the participants was 58.5 ± 9.3 years. Regarding co-morbidities, 229 (76.3%) had at least one co-morbidity other than DM. The majority of participants incorrectly answered 19 out of 32 questions of OKT scale. The mean OKT score was 13.5 ± 4.2 indicating poor osteoporosis - related knowledge. Females had significantly higher nutrition (p = 0.037), exercise (p = 0.043), and OKT score (p = 0.021) than males. Regarding OHBS, female participants had significantly higher belief score of susceptibility (p <  0.01) and seriousness (p <  0.01) of osteoporosis compared to males.

CONCLUSIONS

Diabetic patients had poor osteoporosis knowledge and moderate perception of susceptibility and seriousness of osteoporosis. These results require implementation of awareness programs among DM patients to increase their practices regarding preventive measures of osteoporosis such as calcium intake and exercise.

Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies

PURPOSE

Understanding barriers and facilitators of physical activity participation in persons living with HIV/AIDS is an essential first step in order to devise effective interventions. The present review provides a systematic quantitative review of the physical activity correlates in people with HIV/AIDS.

METHODS

Major electronic databases were searched till August 2016. Keywords included "physical activity" or "exercise" or "sports" and "AIDS" or "HIV".

RESULTS

Out of 55 correlates from 45 studies (N = 13,167; mean age range = 30.5-58.3 years; 63.2% male) five consistent (i.e., reported in four or more studies) correlates were identified. Lower levels of physical activity were consistently associated with older age (6/10 studies), a lower educational level (6/7), a lower number of CD4 cells/μl (7/11), exposure to antiviral therapy (4/6), and the presence of lipodystrophy (4/4). Other important barriers were the presence of bodily pain (2/2), depression (3/3), and opportunistic infections (3/4). Facilitators were a higher cardiorespiratory fitness level (3/3), a higher self-efficacy (2/2), more perceived benefits (2/2), and a better health motivation (3/3).

CONCLUSIONS

The current review has elucidated that participation in physical activity by people with HIV/AIDS is associated with a range of complex factors which should be considered in rehabilitation programs. Implications for Rehabilitation Health care professionals should consider HIV-related bodily pain and feelings of depression when assisting people living with HIV in inititiating and maintaining an active lifestyle. Interventions to improve self-efficacy and motivation, and to help people living with HIV in understanding the benefits of exercise, may encourage greater participation.

Which HIV patients should be screened for osteoporosis: an international perspective

PURPOSE OF REVIEW

This review provides international insights into the real-world clinical approach to screening for bone mineral density (BMD) and osteoporosis in people living with HIV (PLWH) using opinions from HIV physicians from key regions around the world.

RECENT FINDINGS

Although a significant proportion of PLWH are aged over 50, the relative importance of low BMD to clinical care differs significantly between countries and regions, based on factors such as the population at risk, access to adequate screening resources, and physicians' knowledge. Generally, management of osteoporosis in PLWH follows similar principals as for the general population, with risk factors for fracture combined with measurement of BMD by dual energy X-ray absorptiometry in algorithms such as Fracture Risk Assessment Tool, designed to provide an overall risk estimation. Although in most regions age is considered among the most important factors contributing to low BMD and fractures, considerable country and region-specific factors become apparent, such as malnutrition, inactivity and impact of comorbidities, substance abuse, and increasing use of tenofovir disoproxil fumarate.

SUMMARY

These opinions highlight the diversity that still exists in the approach to the long-term management of PLWH and highlight challenges facing development of consensus guidelines that can be effectively implemented worldwide.

Global physical activity levels among people living with HIV: a systematic review and meta-analysis

PURPOSE

It is unclear how much physical activity people living with HIV (PLWH) engage in. We conducted a meta-analysis to investigate physical activity levels and its predictors in PLWH.

METHODS

PubMed, PsycARTICLES, and CINAHL Plus were searched by two independent reviewers from inception till 1 April 2016 using the keywords: "HIV" OR "AIDS" AND "physical activity" OR "exercise" OR "sports". A random effects meta-analysis was conducted.

RESULTS

Across 24 studies including 34 physical activity levels there were 3780 (2471♂) PLWH (mean age range: 37-58 years). PLWH spent 98.9 (95%CI = 64.8-133.1) minutes per day being physically active which is lower than in most other populations with chronic diseases. 50.7% (95%CI = 39.3-62%) (n = 2052) of PLWH complied with the physical activity guidelines of 150 min moderate intensity physical activity per week. The number of steps walked per day in 252 PLWH was 5899 (95%CI = 5678-6418), which is below the 10,000 steps per day recommendation.

CONCLUSIONS

Our data demonstrate that a considerable proportion of PLWH are insufficiently physically active. Future lifestyle interventions specifically targeting the prevention of physical inactivity in PLWH are warranted. Implications for Rehabilitation Many people living with HIV do not comply with general health recommendations. Physical activity counseling should be key in the rehabilitation of people living with HIV.