Knowledge of osteoporosis among women in Alexandria (Egypt): A community based survey

Osteoporosis: a problem still faulty addressed by the Romanian healthcare system. Results of a questionnaire survey of people aged 40 years and over

Purpose

We aimed to investigate the knowledge and awareness level of osteoporosis, its risk factors, the possible causes of underdiagnosis, as well as the preventive measures and lifestyle behavior of the Romanian population.

Patients and methods

A non-interventional, cross-sectional study was performed, consisting of an in-person survey, in 10 pharmacies located in both urban and rural settings in Romania. The survey was distributed to patients ≥40 years old.

Results

Of 189 respondents, 78.8% were women, the majority age group being 60-69 (31.7%) and 50-59 (30.7%) years old and coming from urban areas (69.3%). Although 75.1% of participants declared knowing about osteoporosis, having a moderate level of knowledge, and women being more aware of the pathology, 77.3% have never performed a DXA test. Moreover, participants already diagnosed with osteoporosis did not show a better disease knowledge than those without a diagnosis. Nearly half of the respondents did not know that a family history of the disease increases the risk of developing it and 60% of them thought that symptoms may develop before a fracture occurs. The preventive strategies tend to be disregarded and thus, underused. Moreover, 42.9% of participants reported being diagnosed with osteoporosis, do not undergo treatment, although they are aware of the existence of effective strategies. The dataset was used to build a participant compatibility network. The network's clustering revealed six relevant communities, which are not correlated with questionnaire results but reflect the patterns of feature associations.

Conclusion

Preventive and therapeutic osteoporosis education programs are urgently needed in the Romanian population to decrease disability and high mortality risks and thus, to improve the quality of life.

Knowledge, Attitudes, Practices, and Awareness Levels Among Indian Postmenopausal Women About Osteoporosis and Its Relationship With Sociodemographic Factors: A Cross-Sectional Study From Northern India

Background Osteoporosis is a silent disease and can be prevented by providing correct and appropriate information to the individuals at risk. Therefore, we aim to find out the levels of knowledge, attitudes, and behaviors of postmenopausal women, the highest-risk group. Methods Between May 2021 and December 2023, a cross-sectional study was done in the Military Hospital in Ambala, India, in 1326 postmenopausal women of age between 45 and 70 years who visited the outpatient department of orthopedics and who previously had a measure of bone mineral density (BMD) or estimation of BMD. All patients participating in the study received a questionnaire that assessed the level of knowledge, attitudes, and behaviors related to osteoporosis. The Osteoporosis Knowledge Assessment Tool (OKAT) was used to assess these parameters. Results The mean age was 60±3.1 years. The mean score for osteoporosis awareness was 6/20 points. A total of 983 (73.13%) had no knowledge about osteoporosis, and 221 (16.66%) had higher knowledge. Knowledge about osteoporosis was low with a mean knowledge score of 7.44±3.16 and a median of 7.2. It was found that those who graduated had some knowledge regarding osteoporosis with the help of either a hospital staff or a family member who had a history of osteoporosis. Conclusions Even among postmenopausal women who know they are at risk and should have BMD, knowledge, attitudes, and behaviors about osteoporosis were found to be quite low. In addition, education and mass communications are needed to increase awareness among women of this age about improving bone health.

Assessing the knowledge, attitude and practice of osteoporosis among Pakistani women: A national social-media based survey

BACKGROUND

There are numerous risk factors for osteoporosis and understanding and recognizing these risk factors is critical when deciding whether to take preventive measures. It is critical to reduce the healthcare expenditure burden of the Pakistani population by raising awareness and implementing osteoporosis-preventable measures. This survey aims to assess the knowledge, attitudes, and practices (KAP) of Pakistani women as well as their misconceptions about osteoporosis.

METHODS

A cross-sectional survey was conducted from August 2021 to January 2022 by the Bone & Mineral Disease research group at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, with exemption from the ethical review committee. Using snowball sampling, a validated Osteoporosis Prevention and Awareness Tool (OPAAT) was disseminated online via social media. With informed consent, 400 Pakistani women aged ≥ 18 years were included in the study. SPSS Statistics version 25.0 was used for data analysis. Chi-square test for association and Fisher-exact test were applied, and significance level was α<0.05.

RESULTS

Based on the OPAAT scores of all (n = 400) participants, 22% (n = 88) had low knowledge, 44% (n = 176) had average knowledge, while 34% (n = 136) had good knowledge of osteoporosis. The most common misconceptions were about age-related risk, presentation of symptoms, radiation risk, associated risk factors like tooth loss, osteoarthritis, and knowledge about predictors of bone health.

CONCLUSION

Adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle.

Health economics: direct cost of osteoporotic hip fracture in Egypt—an analysis for the Egyptian healthcare system by the Egyptian Academy of Bone Health

Mini abstract

This work studies the direct cost of hip fractures in Egypt. The direct cost was calculated based on the incidence of hip fracture in Egypt retrieved from the national database. The result of this work raises red flags to the policy makers in Egypt that such fragility fractures are preventable, should appropriate approaches be implemented.

Background

This study provides an analysis for the healthcare system in Egypt. It was carried out to assess the direct annual cost incurred to the Egyptian healthcare system in 2023 as a result of fragility hip fractures in older adult Egyptians.

Results

The direct costs of hip fractures incurred during the first year after the injury were estimated at 1,969,385,000 Egyptian pounds (US $63,734,142.4). Time from fracture to surgery was 2.2 + 0.5 days. The average hospital stay after hip fracture surgery was 5.2 + 2.6 days. 4.5% of patients died after surgery, on average 2.3 + 0.4 months. After being discharged from the hospital, all patients needed home care.

Conclusion

Hip fractures have a significant clinical and financial impact on patients and the healthcare system. This study raises red flags for the healthcare policy makers in Egypt, as the financial burden due to the direct costs of hip fractures justifies extensive prevention programs for osteoporosis and fragility fractures. There is an urgent need to implement diagnostic approaches and validated management protocols for bone health disorders and its associated fractures in Egypt.

Osteoporosis treatment gap in patients at risk of fracture in Egypt: a multi-center, cross-sectional observational study

Despite the wide availability of a wide variety of approved osteoporosis medications and DXA scan centers in Egypt, only a minority of patients at high risk of sustaining a fragility fracture receive treatment, even after their first fracture. Such big "treatment gap" leaves the most high-risk individuals unprotected against fragility fractures. This study provides a benchmark to monitor national trends in osteoporosis management and service uptake.

PURPOSE

To assess the treatment gap among men and postmenopausal women presenting with a fragility fracture, and to analyze the characteristics and fracture risks of the patients presenting with an index fragility fracture.

METHODS

This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work. The fracture risk was assessed based on their FRAX calculation prior to the index fracture. All the patients were assessed for their falls and sarcopenia risks. Blood tests for bone profile as well as DXA scan were offered to all the patients.

RESULTS

Two hundred and thirty-six patients presenting with fragility fractures were included in this work. 70.8% were women and 29.2% were men. Mean age was 70.1 (SD = 9.2) years. Ten-year probability of fracture (without BMD) was high in 65.9% of the postmenopausal women and 40.3% of the men. 82.1% of the postmenopausal women and 100% in men identified to be eligible for osteoporosis therapy did not receive any form of osteoporosis therapy. FRAX score correlated significantly with bone mineral density assessment at both hip and spine. Falls, sarcopenia, and functional disability showed significant relation to the fracture risk.

CONCLUSIONS

There is a large treatment gap in Egyptian older adults. The recent guidelines for osteoporosis management in Egypt endorsed fracture centric approach to identify people at risk. The gap appears to be related to a low rate of osteoporosis diagnosis and lack of patient education.

A Study to Assess the Osteoporosis Knowledge and Preventive Practice among Menopausal Women: A Community Based Survey

Background and Objectives Osteoporosis is a multifactorial and slowly emerging global health problem. Along with menopause, one out of three women between the age group of 50 to 60 years in India suffers from osteoporosis. Indian women have an early age onset of osteoporosis as compared to their Western counterparts. The current study assessed osteoporosis knowledge and preventive practice among menopausal women. The study's objectives were to 1) assess the osteoporosis knowledge and preventive practice among women, 2) find the correlation between the knowledge and preventive practice among menopausal women, and 3) find the association of knowledge and preventive practice with selected demographic variables.

Methods A quantitative nonexperimental research approach with a descriptive correlational survey design was adopted in the study. A total of 100 samples between the ages of 45 and 56 years were the participants. Data were collected using demographic proforma, a self-structured knowledge questionnaire, and a preventive practice checklist. Descriptive and inferential statistics were used to analyze the data.

Results The majority of the menopausal women (65%) were between the age group of 53 and 56 years and 79% of menopausal women were having primary education, 77% of them were unskilled workers. Fifty percent of the participants had shown adequate knowledge with a median score of 12 and the remaining half of the participants had a knowledge score < 12. The knowledge score among women was 11.47 ± 2.4 with a maximum score of 17 and the minimum score of 5. With regard to the preventive practice, the participants were 20.12 ± 2.22.

Conclusion The study showed a gross deficit in osteoporosis knowledge among menopausal women and they were following unhealthy practices in their lifetime. There is a need to prioritize designing appropriate awareness campaigns regarding osteoporosis among subjects who are at risk, according to their level of literacy.

Evaluation of Bone Mineral Density, Serum Osteocalcin, and Osteopontin Levels in Postmenopausal Women with Type 2 Diabetes Mellitus, with/without Osteoporosis

OBJECTIVE

Osteoporosis (OP) is a worldwide ailment; we aim to establish new biomarkers in diagnosis by determining the levels of serum osteocalcin and osteopontin along with bone mineral density (BMD) and lumbar T-score, in postmenopausal women with type 2 diabetes mellitus (T2DM) with or without OP.

METHODS

This observational study included 160 postmenopausal women who were an attendee at outpatient clinics in Al-Hussein Hospital, Thi-Qar province; subdivided into 3 groups based on their T-score testing: Group I (n = 40) comprised postmenopausal women without T2DM as controls, Group II (n = 60) comprised postmenopausal women with T2DM but without OP, and Group III (n = 60) comprised postmenopausal women with T2DM with OP. The dual-energy X-ray absorptiometry was used to measure the BMD (total body, lumbar spine, and femoral) and T-score for lumbar spine and femoral. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), osteocalcin, and osteopontin levels were assessed in all three groups.

RESULTS

Compared with controls, Group III demonstrated significantly lower BMD (total body, lumbar spine, and femoral), T-score for lumbar spine and femoral, serum osteocalcin, and osteopontin levels than Group II and Group I (P < 0.001). FBG and HbA1c levels were significantly higher in Group III than in Groups I and II (P < 0.001). A negative correlation was proved between HbA1c levels with BMD, osteocalcin levels, and osteopontin levels in the three groups.

CONCLUSIONS

Iraqi postmenopausal women with T2DM had a significantly lower bone mineral density, serum osteocalcin, and osteopontin levels. These results may serve as adjuvants in screening for OP, particularly among diabetic patients.

Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases

Background

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service.

Results

The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested.

Conclusion

A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management.

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.

Osteoporosis in Africa-where are we now

Africa is experiencing an exponential increase in the number of older persons. The number of persons surviving with human immunodeficiency virus is simultaneously increasing due to improved availability of anti-retroviral therapy. The burden of non-communicable diseases, in particular, osteoporosis and its consequent fragility fractures, is also predicted to increase. Osteoporosis, however, remains a neglected disease and there are no age-standardized reference data available to accurately screen and diagnose individuals with osteoporosis. Epidemiological studies reporting the incidence of hip fracture or vertebral fractures are limited from Africa, especially Sub-Saharan Africa. The studies are usually limited as they are based on a retrospective data and small study numbers and often from a single study site. However, compared with early initial studies, the more recent studies show that osteoporosis and fractures are increasing across the continent. The overall incidence rates for osteoporosis and fractures still vary greatly between different regions in Africa and ethnic groups. Predisposing factors are similar with those in developed countries, but awareness of osteoporosis is sorely lacking. There is a lack of awareness among the population as well as health authorities, making it extremely difficult to quantify the burden of disease. There is great potential for research into the need and availability of preventive strategies. The FRAX® tool needs to be developed for African populations and may circumvent the shortage of bone densitometry.

Osteoblast-Based Therapy-A New Approach for Bone Repair in Osteoporosis: Pre-Clinical Setting

BACKGROUND

Osteoporosis is a metabolic bone disease characterized by low bone density resulting in increased fracture susceptibility. This research was constructed to uncover the potential therapeutic application of osteoblasts transplantation, generated upon culturing male rat bone marrow-derived mesenchymal stem cells (BM-MSCs) in osteogenic medium (OM), OM containing gold (Au-NPs) or gold/hydroxyapatite (Au/HA-NPs) nanoparticles, in ovariectomized rats to counteract osteoporosis.

METHODS

Forty rats were randomized into: (1) negative control, (2) osteoporotic rats, whereas groups (3), (4) and (5) constituted osteoporotic rats treated with osteoblasts yielded from culturing BM-MSCs in OM, OM plus Au-NPs or Au/HA-NPs, respectively. After 3 months, osterix (OSX), bone alkaline phosphatase (BALP), sclerostin (SOST) and bone sialoprotein (BSP) serum levels were assessed. In addition, gene expression levels of cathepsin K, receptor activator of nuclear factor-κb ligand (RANKL), osteoprotegerin (OPG) and RANKL/OPG ratio were evaluated using real-time PCR. Moreover, histological investigation of femur bone tissues in different groups was performed. The homing of implanted osteoblasts to the osteoporotic femur bone of rats was documented by Sex determining region Y gene detection in bone tissue.

RESULTS

Our results indicated that osteoblasts infusion significantly blunted serum BALP, BSP and SOST levels, while significantly elevated OSX level. Also, they brought about significant down-regulation in gene expression levels of cathepsin K, RANKL and RANKL/OPG ratio versus untreated osteoporotic rats. Additionally, osteoblasts nidation could restore bone histoarchitecture.

CONCLUSION

These findings offer scientific evidence that transplanting osteoblasts in osteoporotic rats regains the homeostasis of the bone remodeling cycle, thus providing a promising treatment strategy for primary osteoporosis.

Dietary Pattern and Bone Health in Pre and Post-menopausal Obese Women

BACKGROUND AND OBJECTIVE

Obesity and osteoporosis are worldwide health problems that interact with each other. There are also affected by the menopause and dietary pattern. So, this study aimed to find the relation between osteoporosis, body weight and intake of protein, calcium and vitamin D in obese pre and post-menopausal women.

MATERIALS AND METHODS

One hundred and sixteen shared as volunteers in a cross-section study lasted for 2 years. They were divided into 2 groups, pre and post-menopausal women. All women were subjected to, clinical examination, anthropometric measurements and 24 dietary recalls. They were evaluated for bone mass density, biochemical analysis for serum lipids, calcium and vitamin D.

RESULTS

Osteopenia and osteoporosis were higher among normal-weight and overweight (non-obese) women compared to obese as well weakly associated with their serum lipids. The mean daily protein consumption was high as compared to recommended daily allowances (RDAs), especially among osteoporotic women. The mean daily intake of vitamin D and calcium was low as the lower level was noticed among the osteoporotic premenopausal patients. The means serum concentration of calcium and vitamin D were adequate.

CONCLUSION

Data revealed that the prevalence of osteoporosis was lower among obese patients compared to non-obese women. Inadequate daily dietary intake of calcium and vitamin D was reported, however, physiological compensation maintained their optimal normal serum levels.

Levels of Knowledge, Beliefs, and Practices Regarding Osteoporosis and the Associations with Bone Mineral Density among Populations More Than 40 Years Old in Malaysia

Osteoporosis is a skeletal disorder commonly found among the elderly, in which the bones become weak, brittle, and more susceptible to fracture. Adequate knowledge and positive attitude towards the disease and osteoprotective activities may prevent osteoporosis, but comprehensive studies to verify this hypothesis are limited in Malaysia. This study aims to bridge the research gap by determining the levels of knowledge, beliefs, and practices regarding osteoporosis and their associations with bone mineral density (BMD) among men and women ≥ 40 years in Klang Valley, Malaysia. In this cross-sectional study, 786 Malaysians (382 men, 404 women) completed a questionnaire on knowledge, beliefs, and osteoprotective practices, and underwent BMD scan using a dual-energy X-ray absorptiometry device. The current study found moderate levels of knowledge and beliefs regarding osteoporosis but poor osteoprotective practices. Osteoporosis knowledge, beliefs, and practices were significantly different based on subjects' demographic characteristics (p < 0.05). Osteoporosis knowledge and beliefs were correlated significantly with osteoprotective practices (p < 0.05). Bone health status of the subjects was associated positively with calcium supplement intake, and negatively with exercise barriers and smoking status of the subjects (p < 0.05). However, no significant correlation was noted between osteoporosis knowledge and bone health (p > 0.05). Conclusively, despite some correlations between individual components, the detachment between bone health knowledge and beliefs, and osteoprotective practices among Malaysians is apparent. Integrating all three components into a comprehensive osteoporosis prevention program is warranted.

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.

Osteoporosis strategic plan for the Middle East and North Africa region

The first step to achieve a world without fragility fractures is to devise a strategic plan to improve research and planning, and assisting member states to acquire the required financial, technical, and other resources. This article aims to outline the first strategic plan devised for the Middle East and North Africa region proposed by the International Osteoporosis Foundation's (IOF) Middle East and North Africa (MENA) Regional Advisory Council (RAC).

PURPOSE

Osteoporosis is no exception in this rising tide of non-communicable diseases, not only sharing common risk factors but also contributing substantially to a heavy social and economic burden on society. During the past decade and after the establishment of the International Osteoporosis Foundation (IOF), a goal-directed movement has started to achieve a world without fragility fractures. In order to achieve this goal, regional councils were formed to maximize the effectiveness of national osteoporosis societies in raising awareness of effective prevention, diagnosis, and treatment strategies.

METHODS AND RESULTS

The first step to achieve this goal is to devise a strategic plan to improve the research and planning, assisting all member states to acquire the financial, technical, and other resources needed in order to achieve a world-class program in the fight against osteoporosis.

CONCLUSION

This article therefore aims to outline the first strategic plan devised by the IOF's MENA RAC for the Middle East and North Africa region.

Rheumatology in Egypt: back to the future

Medical knowledge in ancient Egypt had a remarkable reputation since rulers of other empires used to request the pharaoh to send them their best physician to treat their beloved ones. Many rheumatologic conditions as giant-cell arteritis, reactive arthritis and other forms of spondyloarthritis have been identified in ancient Egyptian materials. Rheumatologists in Egypt are enormously expanding and mastering the tools that aid them in enhancing the management of rheumatic diseases. More Egyptian rheumatologists are actively participating in the annual European League Against Rheumatism (EULAR) and American College of Rheumatology conferences and those attached to well known state of the art centers are increasing. EULAR certified Egyptian MSUS trainers are effectively performing regionally. This review throws light on the rheumatology practice in Egypt, its progress from ancient times passing through Egyptian medical healthcare services, education systems for rheumatologists, rheumatology associations, an overview on the spectrum of rheumatic diseases through publications in the field till future perspectives. Rheumatology in Egypt is an actively growing and dynamic specialty of medicine with considerable contributions to the world's literature. These days, persistent efforts are mandatory to raise the standard of clinical and basic research, to optimize clinical practice with regard to new biologics, to develop tailored and targeted therapies for the rheumatic diseases, and to meet the medical demands of the exponentially increasing Egyptian population. Opportunities and challenges discussed high-lighten future perspectives needed to boost the rheumatology practice in Egypt.