Inter-correlation of knowledge, attitude, and osteoporosis preventive behaviors in women around the age of peak bone mass

Effect of educational intervention on preventing osteoporosis in postmenopausal women

In the experimental group, the average scores of knowledge, constructs of theory of planned behavior, nutrition, and walking had a significant enhancement compared to the control group after the educational intervention. After the intervention, the value of the lumbar spine bone mineral density T-score in the experimental group increased, while in the control group, it decreased.

INTRODUCTION

Osteoporosis is a global public health problem currently affecting millions of people worldwide and in Iran. This study was conducted to assess the effect of an educational intervention based on the theory of planned behavior on the prevention of osteoporosis in postmenopausal women.

METHODS

This quasi-experimental study was performed on 160 women aging over 50 who were referred to health centers in Fasa City, Iran, in 2019. A simple random sampling method was applied to assign the participants into control and intervention groups (80 participants for each group). Data were gathered by questionnaires arranged based on the constructs of the theory of planned behavior, nutrition performance, and walking performance. The educational intervention included seven 50-minute educational sessions. The obtained data were analyzed using SPSS 22 software and Chi-square test, independent T-test, and paired T-test, and the significance level was considered 0.05.

RESULTS

The mean ages of the studied participants in the experimental and control groups were 59.18 ± 6.56 and 57.92 ± 5.70, respectively. In the experimental group, the average scores of knowledge, constructs of the theory of planned behavior, nutrition performance, and walking performance had a significant enhancement compared to the control group one year after the intervention (p < 0.001). At 12 months after the intervention, the value of the lumbar spine bone mineral density T-score in the experimental group increased, while in the control group, it reduced (p < 0.001).

CONCLUSIONS

The theory of planned behavior affected nutrition and walking performance in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational interventions for preventing osteoporosis and promoting women's health.

Assessment of Knowledge, Physical Activity and Calcium Intake among Female University Students

Insufficient calcium intake and being physically inactive lead to osteoporosis. This study aimed to assess the level of knowledge about osteoporosis, physical activity levels and their correlation with calcium intake. 276 female undergraduate students participated in this study. A set of questionnaires was distributed. Majority students had low knowledge (76.1%), moderate physical activity level (47.1%) and did not meet the recommended calcium intake (79.0%). There was a moderate to strong positive correlation but not significant between knowledge (r= 0.051, p=0.121) and physical activity (r = 0.081, p=0.181) to dietary calcium intake. In conclusion, students had poor knowledge about osteoporosis.

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.

Development and Validation of the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire for Female Osteoporosis Patients in Taiwan: A Mediation Model

This research develops the Osteoporosis Knowledge, Attitude and Behaviors Questionnaire (OKABQ) with the intent to evaluate the levels of osteoporosis knowledge, attitude and behavior change by developing and validating the OKABQ while establishing a mediation model of the research. A quantitative, descriptive and instrumental study was conducted in two phases: Phase I—development of the scale through Delphi Method by osteoporosis experts; and Phase II—evaluation of the validity and reliability of the scale and construction of a mediation model using SmartPLS. In Phase I, the content validity index (CVI) of the questionnaire was higher than 0.96 and the inter-rater reliability (IRR) kappa was 1.00. In Phase II, exploratory factor analysis showed that two predominating factors of attitude as a mediation were addressed by the 26-item OKABQ. The indirect effect results from the estimated model indicate that attitude mediates the relationship between knowledge and behaviors (β = 0.114, t = 2.627, p < 0.001), which is positive and statistically significant. We concluded that the OKABQ is a valid measure of osteoporosis knowledge, attitudes and behaviors for women with osteoporosis. These assessment results could assist healthcare providers in mitigating insufficiency in health education and help patients better adapt to a more active bone-healthy lifestyle.

Assessing the Knowledge and Attitude towards Osteoporosis among Syrian Women: A Cross-Sectional Study

BACKGROUND

Osteoporosis is a progressive decline in the bone mass, which occurs with no alterations to the bone's composition. It is associated with increased bone fragility that may eventually lead to fractures. In this study, we aim to assess the level of awareness that Syrian women possess regarding osteoporosis and spread the knowledge about its prevention measures.

METHODS

This study was approved by the Institutional Review Board of the Syrian Private University. A validated questionnaire was asked to be filled in by women aged 18 and above, who were presented to clinics at Damascus, Al Helal, and Al Zahrawi hospitals between 28 November 2021 and 5 March 2022.

RESULTS

6082 women were included, of which 63.9% (n = 3884) were under 30 years old and 89.3% (n = 5429) were in their reproductive age. The average knowledge score of osteoporosis was 69.2 ± 7.7 (28-100); 88.1% correctly defined osteoporosis while the majority (93.4%) has heard of it. The majority of our participants were living in rural areas (77.2%; n = 4698) while only 22.8% (n = 1384) were living in urban areas. The respondents from urban areas reported the highest knowledge scores (OR = 1.472; 95% CI: 1.258-1.723; P < 0.0001). 75.60% agreed that aging is a risk factor for osteoporosis. 64.6% were aware that osteoporosis is directly responsible for hip fractures. Smoking, family history, lack of exercise, and menopause were the main risk factors for osteoporosis, at 53.6%, 53.1%, 84.6%, and 60.7%, respectively. Social media represented the ultimate source of information on osteoporosis (64.70%).

CONCLUSION

Our study is the largest in the region and the first of its kind in the country. Syrian women had an average knowledge score regarding osteoporosis; the vast majority has defined it correctly and has heard of it. We found no statistical significance between age or educational level and adequate knowledge about osteoporosis.

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 $$\pm$$ ± 5.20 and 42.94 $$\pm$$ ± 5.52. In experimental group, the average scores of knowledge [2 weeks (31.12 $$\pm$$ ± 4.20) and 2 months (39.04 $$\pm$$ ± 4.10) after educational intervention (p < 0.001)], constructs of theory of planned behavior [attitude construct: 2 weeks (89.32 $$\pm$$ ± 9.22) and 2 months (98.57 $$\pm$$ ± 9.13) after educational intervention (p < 0.001), Subjective norms construct: 2 weeks(88.39 $$\pm$$ ± 8.84) and 2 months (122.57 $$\pm$$ ± 8.58) after educational intervention (p < 0.001), Perceived behavioral control construct: 2 weeks (88.56 $$\pm$$ ± 8.38) and 2 months (120.15 $$\pm$$ ± 8.33) after educational intervention (p < 0.001), Behavioral intention construct: 2 weeks (54.44 ± 4.72) and 2 months (60.26 $$\pm$$ ± 4.12) after educational intervention (p < 0.001)], nutrition performance [2 weeks (19.88 ± 2.56) and 2 months (24.14 $$\pm$$ ± 2.36) after educational intervention (p < 0.001)] and physical activity [2 weeks (16.75 $$\pm$$ ± 1.42) and 2 months (18.94 $$\pm$$ ± 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.

Environmental and personal factors for osteoporosis or osteopenia from a large health check-up database: a retrospective cohort study in Taiwan

Background

Osteoporosis is an important public health issue in aging societies because of its associated morbidity, mortality, and decreased quality of life. The study aims to identify the association of low bone mineral density, including osteoporosis and osteopenia, with environmental and personal factors.

Methods

The data of participants aged ≥ 20 years with multiple visits were obtained from a health check-up database in Taiwan from 2008 to 2016. Multivariable logistic regressions were performed to identify the selected factors associated with low bone mineral density for multiple visit data.

Results

A total of 194,910 participants with 359,943 visits were included in this study. The prevalence of low bone mineral density (BMD) in the study population was 10.6% (n = 20.615). Older women, ever and current smokers (odds ratio (OR) = 1.04 [95% confidence interval (CI) = 1.01, 1.08]), or participants who were underweight (OR = 1.72 [1.64, 1.81]), consumed a vegetarian diet (OR = 1.32 [1.25, 1.39]), or had higher triglyceride levels (OR = 1.04 [1.01, 1.06]) were significantly associated with a higher risk of low BMD. Participants who had higher educational years (OR = 0.43 [0.41, 0.46]), higher physical activity (OR = 0.93 [0.89, 0.97]), appropriate sleep duration and better quality (OR = 0.98 [0.97, 0.99]), dairy intake (≥ 1 slice of yogurt or cheese/week, OR = 0.97 [0.95, 0.99]), higher uric acid (OR = 0.93 [0.91, 0.95]), higher walkability (OR = 0.997 [0.995,0.999]), and higher solar radiation exposure (OR = 0.997 [0.97,0.99]) were significantly associated with a lower risk of low BMD.

Conclusion

Interventions in different directions, such as having better health behaviors, increasing sun exposure, and residing in a highly walkable environment, are beneficial for reducing the risk of low BMD.

Knowledge and Preventive Practices About Osteoporosis Among Elementary School Teachers of Bandar-Abbas in 2020

Purpose

To assess knowledge and preventive practices about osteoporosis among elementary school teachers of Bandar-Abbas in 2020.

Materials and Methods

In this cross-sectional study, the schools were selected using simple random sampling, and the teachers were invited to fill out an online questionnaire. The knowledge section of the questionnaire assessed general knowledge and knowledge regarding risk/protective factors, nutrition, and physical activity. The preventive practices section assessed dietary habits using a food frequency questionnaire, asking about 16 items in six groups, intakes of which were compared to the recommendations of the Iranian food pyramid. This section also assessed physical activity using the International Physical Activity Questionnaire.

Results

Totally, 377 school teachers with a mean [standard deviation (SD)] age of 38 (6.7) participated in this study. The level of overall knowledge of 128 (33.9%) teachers was high, 222 (58.9%) moderate, and 27 (7.2%) low. The median [interquartile range (IQR)] intakes of fruits [2 (1-2)] and meats/eggs [1.7 (1.4-2.2)] were adequate, while those of dairy products [1.5 (0.9-2.3)], nuts/legumes [0.5 (0.2-1.1)], and vegetables [0.3 (0.1-1)] were inadequate. The median (IQR) intakes of tea/coffee [1 (0.6-2)] and cola [0.1 (0-0.3)] were considered limited. The physical activity level of 121 (32.1%) teachers was high, 124 (32.9%) moderate, and 135 (35%) low.

Conclusion

Knowledge of the teachers about osteoporosis was moderate, and their preventive practices were somewhat adequate concerning dietary habits and moderate concerning physical activity.

The social-cognitive determinants of calcium intake for preventing osteoporosis in women in Isfahan: A cross-sectional study using path analysis

BACKGROUND

Osteoporosis is a common disease in women over age 45 years. Calcium intake is among the factors that help prevent osteoporosis. Identifying the social-cognitive determinants of calcium intake can have a major role in the development of osteoporosis prevention programs.

MATERIALS AND METHODS

This cross-sectional study was conducted on 400 women aged <50 years from 10 health centers by cluster sampling in Isfahan in 2016. A hypothetical social-cognitive model was assessed using path analysis, and the fit indices and explanatory power of the model were assessed. The constructs, including self-efficacy, outcome expectations, social support, and self-regulation, were taken as the explanatory variables and calcium intake as the criterion variable.

RESULTS

The mean age of the participating women was 34.07 years (standard deviation = 7.99) (range = 19-50), and their mean calcium intake was reported as 909.94 (12. 6) mg/day. The conceptual model was able to explain 73% of the variance in calcium intake and had good fit indices. Self-regulation was identified as the strongest predictor of calcium intake, and outcome expectation was eliminated from the model since it was the weakest explanatory factor of calcium intake.

CONCLUSIONS

The theoretical model of this study is recommended as a suitable framework for the development of targeted osteoporosis prevention interventions.

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.

Screening for Bone Mineral Density and Assessment Knowledge Level of Low Peak Bone Risk Factors and Preventive Practices Among Kuwaiti Future Mothers

Background

Attaining greater peak bone mass (PBM) prior to the onset of bone loss is getting increasing public health attention as healthy strong bones are essential to maintain our life. Females are more susceptible to bone loss. Knowledge and awareness about low peak bone mass and its related risk factors are important contributors to its preventive behavior.

Objective

To screen apparently healthy young Kuwaiti future mothers for low bone mineral density (BMD) and to assess their knowledge level about determinants of PBM and preventive practices.

Methods

A cross-sectional comparative study on 445 eligible women aged 18–35 years (either students or employees from Kuwait University) was performed. Data on socio-demographic and lifestyle variables were obtained by a semi-structured questionnaire. Their knowledge was assessed using the modified Osteoporosis Knowledge Assessment Tool (OKAT). Bone mineral Density (BMD) was measured using Quantitative Ultrasonography (QUS).

Results

More than half (59.3%) of females had poor knowledge. A statistically significant relation was noted between the overall knowledge score and age, college, occupation, and socioeconomic class (P<0.05 for each). Only 13.9% have low Z-score by QUS. By logistic regression, less carbonated beverages and coffee consumption positively affect BMD, while inadequate exercises level, indoor exposure to sunlight, and less frequency of brisk walking negatively affect BMD.

Conclusion

Unacceptable knowledge score significantly associated with BMD Z-score status. More attention should be devoted to education programs targeting adolescents and young females to promote knowledge about PBM and practice towards accrual and maintenance of bone health.

Knowledge and Attitudes of Maintaining Bone Health among Post-Menopausal Women in Malaysia

Introduction

Public awareness of osteoporosis is low among women in the developing countries. Health education was shown to be effective in improving knowledge and awareness on maintaining bone health. This study aims to identify the level of knowledge and attitudes among post-menopausal women in Malaysia on achieving bone health throughout the menopausal transition period.

Methods

A total of 116 post-menopausal female patients of orthopedic menopause clinic were recruited using a purposive sampling approach. Data on osteoporosis awareness and knowledge were collected using validated structured questionnaires Osteoporosis Prevention and Awareness Tool and Osteoporosis Attitude Knowledge Test. The chi-square test was used to determine the association between post-menopausal women's socio-demographic characteristics and their knowledge and attitude towards maintaining bone health.

Results

Participants' age ranged between 49 and 82 years (61.84, SD=7.87). The knowledge of osteoporosis varied significantly by age (p=0.014) and education (p=0.001) among the studied population. No significant diffrences were found for participants' attitude towards bone health.

Conclusion

This study showed that the age and education levels have significantly different knowledge of bone health.

Effect of health literacy among students on the adoption of osteoporosis-preventive behaviors in Iran

BACKGROUND

In chronic diseases such as osteoporosis, understanding the factors that improve prevention, such as health literacy (HL), is essential in reducing the incidence of these diseases. This study aimed to determine the association between HL and adoption of osteoporosis-preventive behaviors among students in Qazvin.

SUBJECTS AND METHODS

This is a cross-sectional study in which 375 female students (aged 15-18 years) at high schools (grades 10^th, 11^th, and 12^th) in Qazvin city were selected, in 2019. Sampling method was multistage. To collect data, the standardized questionnaire for measuring HL in adolescents (health literacy measure in adolescents), in addition to another questionnaire for assessing osteoporosis-preventive behaviors, was used. Data were analyzed using SPSS 22 by descriptive statistics and logistic regression. The association considered significant when P < 0.05.

RESULTS

The mean scores of adoption of osteoporosis-preventive behaviors and HL were 22.43 ± 5.60 and 70.84 ± 12.58, respectively. Logistic regression showed that there was a significant association between the adoption of osteoporosis-preventive behaviors and HL (P = 0.001). In addition, the association between the adoption of osteoporosis-preventive behaviors and age was also significant (P = 0.048 and odds ratio = 3.35).

CONCLUSIONS

Young students and those of low HL showed less adoption of osteoporosis-preventive behaviors. Therefore, it is necessary to pay more attention to design educational programs that may raise the knowledge and awareness of those students about such these diseases, mainly prevention.

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.

Inter - Relationship of Awareness, Knowledge, Attitude, Some Socio-Economic Variables and Osteoporosis in Sample of Egyptian Women

BACKGROUND

Osteoporosis is a global health problem, and its prevalence is rapidly increasing worldwide.

AIM

The aim was to assess the awareness concerning some nutritional and socio-economic variables causes the disease in a sample of Egyptian women.

METHODS

This study was done among 116 female volunteers. They were divided into two groups, pre and post-menopausal, with a mean age of 42.05 ± 8.25 & 51.13 ± 5.82 years and mean body mass index (BMI) of 30.83 ± 8.18 & 34.24 ± 8.80 kg/m². A standardised questionnaire, socioeconomic and food frequency chart were used to assess osteoporosis and food intake awareness. Bone mineral density was measured by dual-energy X-ray absorptiometry (DEXA). Statistical analyses were done using simple percentage and Chi-square test.

RESULTS

Data revealed that a low percentage of pre and post-menopausal women were aware of osteoporosis and fracture (16.67% & 12.96% and 30.65% & 19.35%). They had incomplete knowledge about the sources and the beneficial effects of consumption of calcium and vitamin D rich diet. Non-osteoporotic women showed more awareness. Odds ratio predict occupations and educations levels as risk factors for osteoporosis.

CONCLUSION

Awareness about osteoporosis and consumption healthy diet were low among Egyptian women, so it is important to implement special osteoporosis prevention program.

Osteoporosis knowledge and awareness among university students in Saudi Arabia

Awareness and knowledge about any disease is the first step to prevent and treat it, so this study evaluates osteoporosis awareness and knowledge in university students. Our results showed a high awareness and good knowledge of osteoporosis. Females were better informed than males. Knowledge increased with increasing education level.

PURPOSE

Osteoporosis is a worldwide health problem, including Saudi Arabia where vitamin D deficiency is common. Prevention of osteoporosis must begin by increasing awareness of the disease from a young age. This study aimed to assess awareness and knowledge of osteoporosis among young adults (18-30 years) attending Saudi universities, exploring the relationship between education and gender and the sources of information in this age group.

METHODS

A cross-sectional survey was conducted in 337 students (176 females; 161 males) randomly selected from four Saudi universities during January-December 2017. Education level ranged from preparatory year to undergraduate and postgraduate levels. A self-reported questionnaire was designed to assess awareness and knowledge of osteoporosis across several domains, including risk factors for the disease, prevalence, symptoms, prevention, and treatment.

RESULTS

Overall, 92% of students had some awareness of osteoporosis through a variety of sources, predominantly via friends. Just over half of all students had a good or high knowledge level overall (53.4 ± 16.6%). Knowledge score correlated with education (r² = 0.28) and gender (r² = 0.27); p < 0.0001. Females were better informed than males (57.7 ± 15.4% vs 48.8 ± 16.8%; p < 0.0001). Knowledge increased with increasing education level (preparatory year (47.8 ± 15.3%), undergraduate (53.5 ± 16.5%), and postgraduate (61.8 ± 15.8%); all p < 0.0001).

CONCLUSION

Knowledge of osteoporosis was good among university students in Saudi Arabia, higher in females and with increasing years of education. Overall, students were more knowledgeable about risk factors compared to other aspects such as symptoms, prevention, or treatment of osteoporosis.

Total flavonoid extract of Epimedium herb increases the peak bone mass of young rats involving enhanced activation of the AC10/cAMP/PKA/CREB pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Epimedium sagittatum brevicornum Maxim. is an important traditional Chinese herb that has long been used to promote bone fracture healing and treat osteoporosis.

AIM OF THE STUDY

Achieving peak bone mass by adolescence has now been accepted to be fundamental for preventing osteoporosis in adulthood life. This study investigated the possibility of increasing peak bone mass in young rats using the total flavonoid extract of Epimedium herb (TFE).

MATERIALS AND METHODS

TFE was intragastrically administered to one-month-old Wistar rats at a low (100 mg/kg), middle (200 mg/kg) or high dose (400 mg/kg). Whole body bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry every two weeks. When BMD of any one of TFE groups was found to be significantly higher than that of the control, all rats were sacrificed, serum samples were collected for bone turnover biochemical assays, and femurs, tibiae and vertebrae were isolated and used in BMD, mechanical, micro-structural, histomorphometric and mechanistic studies.

RESULTS

Administration of TFE at middle and high doses for two months significantly increased the whole body, femoral and vertebral BMDs, and improved the bone mechanical and micro-architectural properties. The serum turnover biochemical results and the enhanced expression levels of bone-formation regulatory genes (Runx-2, OSX, and BMP-2) demonstrated that TFE administration increased bone formation but had no effect on bone resorption. The increased phosphorylation levels in femurs of PKA and CREB and expression of AC10 (the only soluble form of adenylyl cyclase) and the increased serum cAMP level after 4 h of TFE administration indicated that TFE promoted bone formation by activating the AC10/cAMP/PKA/CREB pathway in vivo.

CONCLUSIONS

Oral administration of TFE at 200 mg/kg for two months can increase the peak bone mass of growing rats, suggesting the possibility of using total flavonoid extract of Epimedium herb to increase the peak bone mass in adolescence which is important for preventing osteoporosis in adult life.

A Review of Knowledge, Belief and Practice Regarding Osteoporosis among Adolescents and Young Adults

Osteoporosis is a major public health problem affecting millions of people worldwide. Increasing knowledge, correcting health belief and promoting osteoprotective practices are effective measures for building and maintaining strong bone throughout ones’ life-span. This review aims to summarize the contemporary evidence on the knowledge, beliefs and practice of adolescents and young adults on bone health. We performed literature searches using the PubMed and Scopus databases to identify original studies from 2008 to May 2018 using the search terms “(knowledge OR beliefs OR attitude OR practice OR behaviours OR physical activity OR exercise OR diet OR nutrition) AND (young OR youth OR adolescents OR children OR young adults OR students OR teenager) AND (osteoporosis OR bone health)”. Of the 3206 articles found, 34 met the inclusion criteria. Studies showed that most adolescents and young adults had poor knowledge and expressed disinterest in osteoporosis. They believed that other diseases were more serious than osteoporosis, contributing to low perceived susceptibility and seriousness towards this disease. Popular media emerged as a platform to obtain information regarding osteoporosis. The lack of knowledge and misconceptions about osteoporosis led to poor osteoprotective practices. As a conclusion, the current evidence revealed a lack of awareness about osteoporosis among adolescents and young adults. Educational interventions may be useful to improve the awareness of osteoporosis among this population.

Awareness of osteoporosis among female head of household: an Iranian experience

More than 81% of the studied women had a poor knowledge of different aspects of osteoporosis and its complications, suggesting that more educational programs targeting women in particular are needed to help improve the osteoporosis practice in the societies and reduce the burden of the disease.

PURPOSE

The family structure has changed considerably in the past decade. But, women from Iran and many countries in the region and even families with similar cultural background living in other parts of the world are still responsible for childcare as well as the lifestyle adapted by the family. The present study was conducted to assess the awareness of the female head of household of osteoporosis and its complications.

METHODS

As part of a population-based study in two Iranian cities, Arak and Sannandaj, to study osteoporosis and its risk factors, a questionnaire on the knowledge of female head of households of osteoporosis and its complications was completed. The subsample filled out the knowledge survey along with the questionnaire on their demographic data, socioeconomic status (SES), reproductive factors, bone-related lifestyle habits, family and personal medical history, medication use, and compliance with osteoporosis medication (if used) as well as a FFQ filled out for all the 2100 participants. They also underwent a bone mineral density (BMD) test, and their serum levels of vitamin D were calculated. These data were then used to assess the factors affecting their awareness level.

RESULTS

The knowledge of 81.3% (473) of the studied women was found to be poor on different aspects of osteoporosis and its complications. Multivariate analysis revealed that each level increase in vit D intake tertile increases the chance of higher awareness level in K-Total by 1.5 times. Each level increase in physical activity tertile was associated with a 30.6% lower chance of having a good knowledge.

CONCLUSION

Considering the poor awareness level of the studied women and their poor practice of bone healthy behavior, one could conclude that more programs are needed or the content/delivery style of the existing ones should be optimized.

Chinese Herbal Medicine for Osteoporosis: A Meta-analysis of Randomized Controlled Trials

Osteoporosis is a major public health problem in the elderly population. Several studies have suggested that Chinese herbal medicine has antiosteoporotic activities that might be beneficial for osteoporosis. This study aimed to assess the effectiveness of Chinese herbal medicine in osteoporosis patients. We comprehensively searched for randomized controlled trials (until December 2016) that compared Chinese herbal medicine with Western medicine in adults with osteoporosis and reported bone mineral densities (BMDs). A total of 10 randomized controlled trials were included. The pooled results suggested that the increased spine BMD was lower but not significant in the Chinese herbal medicine group than in the Western drug group (standard mean difference [SMD] = -0.11, 95% confidence interval [CI]: -0.62 to 0.39, p > 0.05). In the subgroup analysis, in postmenopausal women, Chinese herbal medicine also showed a insignificantly higher increment in BMD than the control group (SMD = 0.22, 95% CI: -0.00 to 0.43, p = 0.05). For different treatment durations, subgroups over 6 mo (SMD = 0.09, 95% CI: -0.24 to 0.41, p > 0.05) and less than 6 mo (SMD = -0.25, 95% CI: -1.14 to 0.64, p > 0.05) showed comparable BMDs between the 2 therapies. Our study demonstrated that Chinese herbal medicine alone did not significantly increase lumbar spine BMD. Further studies with better adherence to the intervention are needed to confirm the results of this meta-analysis.

A Survey of Osteoporosis and Breast Cancer Risk Perception among Menopausal and Postmenopausal Women in Hong Kong

OBJECTIVES

A lack of understanding in menopausal and postmenopausal women's (PMW) risk perception towards osteoporosis and breast cancer still exists, which is explored in this study. This information might allow health professionals to conduct interventions to improve health behaviors before menopause-related diseases are imminent.

METHODS

Between 10 December 2015 and 31 January 2016, 573 menopausal or PMW were successfully interviewed on 17 questions, comprising separate sections for osteoporosis and breast cancer. The target respondents were menopausal or PMW aged 45 to 60 years, with no previous diagnosis of osteoporosis or breast cancer, who attended private clinics across Hong Kong for annual physical examination.

RESULTS

Regarding menopausal issues, the top three concerns were osteoporosis and fracture (72%), breast cancer (44%), and sleep disorder/insomnia/headache (40%). Among 314 respondents (55%) who tried to prevent osteoporosis, 74% of them began to do it after they were 40 years old. On the other hand, 65% of respondents never had a bone density test. For respondents who said "I'm too young, so I don't need to check", their mean age was 52 years old. Ninety percent of respondents mistakenly believed that regular breast examination, regular breast massage, drink soy milk, or vaccine can prevent breast cancer.

CONCLUSIONS

This survey revealed osteoporosis and breast cancer as the top concerns among menopausal and PMW in Hong Kong. Inadequate health behaviors and misconceptions still exist despite widespread health education in the recent years.

The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis

Background: Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012.

Methods: A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors – population size and age-gender composition – and three service components – hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) – which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios.

Results: During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022.

Conclusion: Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region.

A cross-sectional study for estimation of associations between education level and osteoporosis in a Chinese men sample

BACKGROUND

The main aim of this study was to evaluate the association between education level and osteoporosis (OP) in general Chinese Men.

METHODS

We conducted a large-scale, community-based, cross-sectional study to investigate the association by using self-report questionnaire to assess education levels. The data of 1092 men were available for analysis in this study. Multiple regression models controlling for confounding factors to include education level were performed to explore the relationship between education level and OP.

RESULTS

Positive correlations between education level and T-score of quantitative bone ultrasound (QUS-T score) were reported (β = 0.108, P value < 0.001). Multiple regression analysis indicated that the education level was independently and significantly associated with OP (P < 0.1 for all models). The men with lower education level had a higher prevalence of OP.

CONCLUSION

The education level was independently and significantly associated with OP. The prevalence of OP was more frequent in Chinese men with lower education level.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02451397 ; date of registration: 05/28/2015).